Surgical treatment of distal end of radius fracture with volar locking plate: Clinicoradiological outcome of 25 cases

Parag M Tank,Nimish B Patel,Rajesh V Chawda,Vijay J Patel,Ejajahmed Ansari

doi:10.18231/2395-1362.2018.0052

Abstract

Introduction: Distal radius reconstruction every time needs aggressive operative intervention is still a debate among researchers and upper extremity surgeons. There is a role of nonoperative treatment in geriatric population and unfit patients. Novel techniques and revolution of implants advocated the best clinical outcome. Materials and Methods: We conducted a prospective study of 25 patients having AO OTA type A, B & C distal radius fractures treated with volar locking plate at our institute between 2015 to 2017. We include all close injuries in skeletally mature patients between ages 20-60 years. Outcome of the study was evaluated by using the Gartland and Werley score modified by Sarmiento & Patient Rated Wrist Evaluation (PRWE) score. Results: 6 patients had AO OTA type A, 11 patients had type B and 8 patients had type C fractures. Mean palmar flexion was 77 degrees. Dorsi flexion was 82 degrees observed. Average supination and pronation were 85 & 80 degrees respectively. Radial & ulnar deviations average 11 and 25 degrees were observed. 80% of the patients had loss of radial inclination less than 9 degrees. All the patients had less than 6 mm radial shortening. Loss of palmar tilt less than 6 degrees was observed. More than 90% of the patients had excellent to good outcome based on Gartland and Werley score. Conclusions: Volar plating is a proven method of choice in majority of distal end radius fractures regardless of comminution and fragments separation. Keywords: Distal radius fractures, Internal fixation, Volar plate, AO OTA fractures.

Highlights

Distal radius reconstruction every time needs aggressive operative intervention is still a debate among researchers and upper extremity surgeons
Materials and Methods In our study, we included 25 patients having lower end of radius fracture coming to our institute as outdoor or emergency department treated with volar locking plates between years 2015 to 2017
Patient’s outcome measurements were determined using the Gartland & Werley score modified by Sarmiento & Patient Rated Wrist Evaluation (PRWE) score

Summary

Introduction

Distal radius reconstruction every time needs aggressive operative intervention is still a debate among researchers and upper extremity surgeons. Materials and Methods: We conducted a prospective study of 25 patients having AO OTA type A, B & C distal radius fractures treated with volar locking plate at our institute between 2015 to 2017. Radial & ulnar deviations average 11 and 25 degrees were observed. 80% of the patients had loss of radial inclination less than 9 degrees. Conclusions: Volar plating is a proven method of choice in majority of distal end radius fractures regardless of comminution and fragments separation. Pathoanatomy & biomechanics of radiocarpal & radioulnar joints have pivotal role in maintaining wrist functions and movements.[5]. Problems associated with these fractures hamper strength of grip and early arthritis with carpal instability. Valid components of treatment strategy includes reduction cast, ORIF with dorsal and volar approach locking plates and external fixators.[6]

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Discussion

Conclusion