Treatment of unstable fractures of the distal radius by internal fixation of locking compression plate with partially reserving pronator quadratus through volar approach

Abstract

Objective To report the clinical efficacy of internal fixation of locking compression plate with partially reserving pronator quadratus through volar approach in the treatment of unstable fractures of the distal radius. Methods From January 2014 to December 2016, 109 cases of unstable fractures of the distal radius were treated with locking compression plate. Part of pronator quadratus was reserved during the operation. The operation time and intraoperative blood loss were recorded. The fracture healing was evaluated by imaging observation. The wrist function was evaluated by Gartland-Werley Scoring Scale. Results The operation time ranged from 50 to 70 minutes with the average being (60±10) minutes. The intraoperative blood loss ranged from 10 to 20 ml with an average of (15±5) ml. All the patients were follow-up for 12 to 36 months with an average of 20 months. All the fractures achieved healing. The healing time ranged from 4 to 8 weeks with the average being 6 weeks. No fracture block displacement, internal fixation failure, locking plate and screw loosening or break, wound infection occurred. The wrist function recovered well. According to Gartland-Werley Scoring Scale, the wrist function was rated excellent in 89 cases, good in 18 cases and fair in 2 cases, with an excellent and good rate of 98.2%. The rupture of extensor hallucis longus tendon 4 months after the operation occurred in 1 case. Thumb extension of extensor pollicis longus muscle tendon was reconstructed by transplantation of palmaris longus tendon 12 months after the operation when removing the internal fixator. Conclusion The unstable fractures of the distal radius can be effectively treated by locking compression plate with partially reserving pronator quadratus through volar approach. It reduces the excessive dissection of the soft tissue, retains the pronator quadratus and has fewer complications, faster fracture healing, better wrist function recovery and definite curative effect. Key words: Radius fractures; Fracture fixation,internal; Locking compression plate; Volar approach