Treatment of Distal Radius Metaphyseal Comminution Fracture by Volar Locking Plate Fixation

Abstract

Objective: The pronator quadratus (PQ) has important functions such as pronation and robust blood supply of metaphysis. However, PQ repair is difficult when using conventional approach, which is necessary to release PQ for volar plate fixation of distal radius fracture. In addition, anatomical reduction is difficult in patients with distal radius metaphyseal comminution fracture. Therefore, the purpose of this study is to compare the results of volar locking plate fixation using PQ sparing technique and conventional volar approach technique for patients with distal radius metaphyseal comminution fracture. Materials and Methods: In total, 30 patients treated with volar locking plate using PQ sparing approach were compared with 29 patients using conventional approach in distal radius metaphyseal comminution fracture. Mean follow-up periods were 19 and 26 months each. Postoperative clinical evaluation was performed with wrist range of motions, pronation power, and modified Mayo wrist score measured at last follow-up. Radiologic evaluation was performed with mean bone union period and measurement of radial length, radial inclination, and volar tilt at last follow-up. Results: Mean range of motion, pronation power, and modified Mayo wrist score were significantly superior in PQ sparing approach group. Bony union was achieved in all two groups. However, mean bone union period was superior in PQ sparing approach group (8.7 weeks in PQ sparing group vs 12.5 weeks in conventional group). Radial length, radial inclination, and volar tilt did not show significant differences. Conclusion: We propose that a volar locking plate fixation using PQ sparing technique is a more effective treatment method than conventional approach for patients with distal radius metaphyseal comminution fracture.