Radial locking compression plate for treatment of distal radius fracture with dorsal instability

Abstract

Objective To investigate the clinical efficacy of fixation of distal radius fracture with dorsal instability with locking compression plate (LCP) via radial approach. Methods From September 2009 to October 2012, 21 cases underwent LCP fixation of the distal radius fracture with dorsal instability via radial approach. The study included 14 males and 7 females (mean age, 54.5 years; range, 38-81 years). Twelve cases were injured in traffic accidents, 7 in falls and 2 in high falls. Fracture AO classification was type A3 in 10 cases, type C1 in 8 cases and type C2 in 3 cases. Two cases (one type A3 and one type C1) had malunion. When the lateral column, intermediate column, radial edge and dorsal plane were exposed by radial incision, LCP fixation with bone grafting was performed to restore the height of radial styloid process, ulnar deviation and palmar tilt. According to the Gartland-Werley score, wrist joint function was evaluated. Results Mean duration of follow-up was 13.5 months (range, 12 to 24 months). Stage Ⅰ bone union was shown on X-rays, with the healing time of 7.5 weeks. Based on the X-rays at postoperative 6 months, 1 year and 2 years, the shortening of radial styloid process was≤2 mm, mean volar tilt was 12.5°(range, 8°-17°), mean ulnar tilt was 20.5°(range, 15°-26°), and step-off or gap of the articular surface was ≤ 2 mm. In postoperative wrist motion assay, mean volar flexion was 60°(range, 30°-70°), mean dorsal flexion was 55° (range, 30°-65°), mean radial deviation was 17°(range, 10°-20°), mean ulnar deviation was 25.5°(range, 20°-30°), pronation was 65.5°(range, 6O°-70°), and mean supination was 75.5°(range, 60°-80°). Mean grip strength was 75%(60%-95%)of the contralateral side. Two cases suffered from pain (one complained of moderate pain and one minor pain occasionally). According to the Gartland-Werley score, 16 cases were rated excellent, 2 good, 2 fair and 1 poor, with the excellent rate of 86%. No complication was found as injury of the superficial branch of radial nerve, infection, nonunion, nail loosening, medium neuritis and tendon injury. Conclusions Lateral column, intermediate column, radial edge and dorsal plane can be shown via the radial approach. LCP fixation combined with bone grafting contributes to fracture anatomical reduction. Key words: Radius fractures; Fracture fixation, internal; Operative approach