Surgical Management of Intra-articular Fracture Distal Radius by Multi axial Locked Plate

Abstract

Background: Early wrist motion and adequate reduction and fixation of fracture fragments including radial styloid process achieved with volar multi axial locked plate have the advantage of minimizing the risk of joint stiffness and radio carpal joint incongruity present in other treatment modalities of distal radius fractures. The aim of this work was evaluation of surgical management of intra-articular fractures of distal end of radius with volar multi axial locked plate. Objective: To compare the radiological and clinical outcomes with volar multi-axial locked plate and other treatment modalities of multi-fragmentary and intra-articular distal radius fractures Patients and methods: This was a prospective study on 20 patients with intra-articular distal radius fractures operated with open reduction and internal fixation with volar multi axial locked plates from February 2018 to March 2020 via trans flexor carpi radialis tendon sheath (modified Henry approach) in 12 patients with radial column involvement, and ulnar (extensile carpal tunnel release approach) in 8 patients with ulnar column involvement. Follow up was carried out for six months. Results: The mean DASH score at 3rd month was 20.5 ± 6.9, while the mean DASH score at 6th month was 7.25 ± 4.1. The mean 3 months Modified MAYO Wrist Score was 81 ± 9.8 (median = 85), while the mean 6 months MMWS was 85.8 ± 12.5 (median = 90) which indicated a good ability of the patient to perform daily activities with minimal difficulty. At six months follow up 12 patients had excellent results, 6 patients had good results, one patient had fair result, and one patient had poor result. Conclusion: Multi axial locked plate has the advantage of purchasing small fracture fragments including radial styloid process, and also allowing for early range of motion exercises which prevent the occurrence of radio carpal joint arthritis or stiffness.