Abstract
BackgroundVolar locking plating remains a popular method for the surgical management of distal radius fractures. Dorsal metaphyseal comminution (DMC) is a common fracture pattern which weakens the stability during fracture fixation. In this study, we aimed to compare the radiographic and functional outcome of the intra- and extra-articular distal radius fractures with DMC following single volar locking plate fixation.Materials and methodsPatients suffered from a distal radius fracture with DMC were reviewed in the clinical database of the authors’ institution between Jan 2016 and Jan 2020. The included patients were classified into the extra-articular (A3) group or the intra-articular (C2 and C3) group according to the AO/OTA system. The radiological parameters, wrist range of motion, and functional outcomes were evaluated following open reduction and volar locking plate fixation.ResultsA total of 130 patients were included in this study with a mean follow-up length of 17.2 months. Compared with the A3 fracture group, no significant fracture re-displacement or reduced wrist ROMs was observed in the C2 fractures after 12-month’s follow-up. However, significantly decreased volar tilt (P = 0.003) as well as the extension/flexion ROMs were observed in the C3 fractures comparing to the A3 fractures. Most of the patients achieved an excellent (n = 75) or good (n = 51) Gartland and Werley wrist score. Four patients with C3 fractures resulted in a fair functional outcome due to a significant loss of volar tilt during follow-up.ConclusionsThe single volar locking plate fixation provided sufficient stability for distal radius fractures with DMC, and resulted in similar radiological and functional outcomes in the intra-articular distal radius fractures with a simple articular component (C2 fractures) as those in the extra-articular fractures. Considering the intra-articular fractures with multifragmentary articular component (C3 fracture), despite of the subsequent loss of volar tilt, the majority of the patients achieved good to excellent wrist function following single volar locking plating.Trial registrationThis study has been registered on the ClinicalTrials.gov.
Highlights
Distal radial fractures are common orthopedic injuries comprising 15% of all extremity fractures [1]
The single volar locking plate fixation provided sufficient stability for distal radius fractures with Dorsal metaphyseal comminution (DMC), and resulted in similar radiological and functional outcomes in the intra-articular distal radius fractures with a simple articular component (C2 fractures) as those in the extra-articular fractures
Considering the intra-articular fractures with multifragmentary articular component (C3 fracture), despite of the subsequent loss of volar tilt, the majority of the patients achieved good to excellent wrist function following single volar locking plating
Summary
Distal radial fractures are common orthopedic injuries comprising 15% of all extremity fractures [1]. Biomechanical studies have testified the stability of volar locking plate in extra-articular distal radius fracture models with DMC, and an equivalent [10] or slightly less stability [4, 11] can be provide compared with dorsal plating. The efficacy of single volar locking plating in the intra-articular distal radius fracture with DMC has not yet been adequately analyzed in biomechanical or clinical studies. The purpose of the present study was to analyze the radiographic and functional outcome of the intra- and extra-articular distal radius fractures with DMC treated with single volar locking plating. We aimed to compare the radiographic and functional outcome of the intra- and extra-articular distal radius fractures with DMC following single volar locking plate fixation
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