Volar fixed-angle plate fixation for unstable distal radius fractures in the elderly patient

Abstract

Purpose Increased incidence of falls and osteoporosis combine to make distal radius fractures a major cause of morbidity for the elderly patient. This report presents our experience treating distal radius fractures in the elderly population using a volar fixed-angle internal fixation plate. Methods We reviewed retrospectively all patients older than 75 years treated during a period of 4 years and 7 months at our centers for unstable distal radius fractures using a volar fixed-angle plate. Postoperative management included immediate finger motion, early functional use of the hand, and a wrist splint used for an average of 3 weeks. Standard radiographic fracture parameters were measured and final functional results where assessed by measuring finger motion, wrist motion, and grip strength. Results Of 26 patients that fit the inclusion criteria, we were able to evaluate 23 patients with 24 unstable distal radius fractures for an average of 63 weeks. Final volar tilt averaged 6° and radial tilt 20°, and radial shortening averaged less than 1 mm. The average final dorsiflexion was 58°, volar flexion 55°, pronation 80°, and supination 76°. Grip strength was 77% of the contralateral side. There were no plate failures or significant loss of reduction, although there was settling of the distal fragment in 3 patients (1–3 mm). Conclusions The treatment of unstable distal radius fractures in the elderly patient with a volar fixed-angle plate provided stable internal fixation and allowed early function. This technique minimized morbidity in the elderly population by successfully handling osteopenic bone, allowed early return to function, provided good final results, and was associated with a low complication rate.