Wrist Stiffness Research Articles

PDMeter: A Wrist Wearable Device for an at-Home Assessment of the Parkinson’s Disease Rigidity

This work focuses on the design and the validation of a wearable mechatronic device for an at-home assessment of wrist stiffness in patients affected by Parkinson's Disease (PD). The device includes one actuated joint and four passive revolute joints with a high overall intrinsic backdriveability. In order to allow the user to freely move the wrist during activities of daily living, we implemented a transparent controller on the basis of the interaction force sensed by the embedded load cell. Conversely, in order to provide perturbations for estimating the wrist flexion-extension rigidity, we implemented a torque controller. Firstly, we report a pilot study that aimed at characterizing the device in terms of range of motion (ROM) allowed, transparency perceived and torque-tracking capability. Then, we present a case study in which we tested our device with seven PD patients in both drug-OFF and drug-ON conditions and we compared the measured stiffness with the one measured in fourteen healthy controls and with the outcome of the most used clinical scale (MDS-UPDRS). The device allowed to successfully estimate the stiffness as different depending on the movement direction. Indeed, extension stiffness was higher than the flexion one, accordingly to the literature. Moreover, the device allowed to discriminate both Healthy subjects from PD subjects, and PD subjects in OFF condition from PD subjects in ON condition. In conclusion, we demonstrate the feasibility of the device in measuring wrist rigidity, thus enabling the possibility to implement an at-home assessment of the PD rigidity.

Effectiveness of Proprioceptive Neuromuscular Facilitation as an Adjunct to Conventional Therapy in Conservatively Managed Distal Radius Fractures: A Randomized Controlled Trial

Background: Distal radius fractures are most common injuries and cast immobilization being the method of traditional treatment. Thereby post immobilization wrist joint stiffness, swelling and pain are seen in patients. Rehabilitation with proprioceptive neuromuscular facilitation techniques (PNF) activates motor units of muscles improving strength, promote movement and return of optimal function. Purpose: The purpose of the study was to find out whether PNF and conventional therapy can bring better functional outcomes in patients with conservatively managed distal radius fractures when compared to conventional therapy alone. Method: 54 subjects with conservatively managed distal radius fractures were selected randomly. The study included 2 groups, control group and experimental group, the outcomes measures included were Numerical rating pain scale (NRPS), range of motion (ROM), Patient-Rated Wrist Evaluation Questionnaire (PRWE), Disabilities of the Arm, Shoulder and Hand Questionnaire (DASH). Results: Both the groups showed statistically significant difference, in all parametric values (P <0.05) at 12th week. The mean difference, chi-square test values and paired t-test values of experimental group were greater in comparison to control group, at the end of 12 weeks. Conclusion: This study concludes that there were significant improvement seen in both the groups in NPRS, ROM, PRWE, DASH but the experimental group treated with PNF along with conventional therapy showed better results than control group treated with conventional therapy alone.

Shi's Yi-Qi Bu-Shen Tong-Luo decoction combined with manipulation in the management of wrist stiffness after distal radius fracture: Study protocol clinical trial (SPIRIT Compliant).

Introduction:Wrist stiffness is a common sequela of distal radial fractures. Manipulation is generally used and effective, but problems exist, such as intense pain, swelling during the process of manipulation and long treatment period. Therefore, a combinative therapeutic strategy is necessary to benefit rehabilitation after distal radius fracture. Shi's Yi-Qi Bu-Shen Tong-Luo decoction (BTD) combined with wrist manipulation has been used in the Shanghai Ninth People's Hospital Huangpu Branch in last few decades. BTD has potential therapeutic effects on rehabilitation after distal radius fracture, which should be evaluated by rigorous clinical trial.Methods/design:A randomized, double-blind, placebo-controlled clinical trial will be conducted to determine the efficiency of BTD in relief of wrist stiffness and pain and function rehabilitation. A total of 80 wrist stiffness patients with or without pain and edema will be enrolled, and treated with wrist manipulation plus BTD or placebo for 4 weeks. The primary outcome measure is the Cooney wrist score. The second outcome measures include pain numerical rating scale, patient rated wrist evaluation, 36-item short form health survey questionnaire, and side effects.Discussion:Although BTD has shown effects on rehabilitation after distal radius fracture in the Shanghai Ninth People's Hospital Huangpu Branch for decades, the universality of this efficacy needs evaluated. The results of this trial will provide a convincing evidence.Trial registration:ChiCTR2000029260, January 19, 2020.

Use of the Bridge Plate Technique for the Treatment of Hamatometacarpal Fracture-Dislocations.

Background: This study aimed to describe a novel surgical technique in which a bridge plate was used for the treatment of hamatometacarpal fracture-dislocations and to assess its radiologic and clinical outcomes. Methods: A retrospective review of 16 patients treated with the bridge plate technique for hamatometacarpal fracture-dislocations was performed between 2010 and 2015. Clinical and radiographic evaluations were performed at months 3, 6, and 12 postoperatively. Active wrist and metacarpophalangeal joint ranges of motion and Quick Disabilities of Arm, Shoulder, and Hand (DASH) scores were recorded for the injured hands. Grip strength data were collected for both the injured hands and the contralateral uninjured hands. Results: All patients included in our study were male (mean age 31 years). The average Quick DASH score was 24.3 ± 9.1 at 3 months, 12.3 ± 7.3 at 6 months, and 6.2 ± 6.6 at 12 months. All patients returned to their original jobs within 5 weeks of the procedure. Grip strength eventually recovered to 90% of that of the uninjured hand, and none of the patients complained of finger or wrist joint stiffness. Conclusions: The use of the bridge plate technique may be an effective alternative treatment for patients with comminuted hamatometacarpal fracture-dislocations.

Study the functional outcome of Barton’s fracture treated with open reduction and internal fixation by volar plating: A prospective study

Aims: To study the functional outcome and duration of union of surgical management of Barton’s fracture of distal radius with volar locking compression plate fixation.Settings and Design: Prospective studyMethods and Material: 56 cases presenting with Barton’s fracture which satisfies inclusion and exclusion criteria admitted in Shri B.M. Patil college, hospital and research centre vijayapura from 2017-2020 who are treated with volar locking plate.Results: In our study 56 cases, there were 29 males, 27 females with mean age of 39.52 years. 85.7% were admitted due to fall on outstretched hand, left side was more common according to 57.1% cases, associated ulnar fractures were found in 76.8% cases. 89.3% cases didn’t have any co-morbidity. 89.3% of the patient had no complication following surgery. Most common complication was wrist stiffness in 7.1% cases followed by surgical site infection 1.8% and complex regional pain syndrome in 1.8% cases according to Disability of Arm, Shoulder and Hand (DASH) score.Conclusions: Initial reduction and stable fixation is the key in prevention of late collapse of distal radius fractures. Stabilizing the fracture fragments with volar locking compression plate and screws in the management of fractures of distal radius is an effective method to maintain reduction and prevent collapse of the fracture fragments. The technique emphasizes that open reduction and internal fixation with volar plating has excellent functional and satisfactory radiological outcome with minimal complications. Hence volar approach and locking compression plate should be the preferred implant for treatment of intra- articular unstable, comminuted fractures of distal end radius.

Anteromedial Release for Posttraumatic Flexion-pronation Contracture of the Wrist: Surgical Technique.

Wrist stiffness can be a complication of trauma. A small percentage of patients fail to improve with nonoperative management and require operative intervention to regain range of motion and function. These group of patients can present with a soft tissue flexion-pronation contracture, which is hypothesized to be caused by capsular contraction of the distal radioulna joint, musculotendinous contracture of the flexor carpi ulnaris, contracture of the volar ulnar carpal ligaments and of the pronator quadratus muscle. This complication significantly restricts functional dart-thrower's range of motion and is highly disabling. A surgical option to manage this condition is release of pathologic structures with an anteromedial approach to the wrist. We describe a safe, effective, and reproducible technique to treat these patients.

Outcomes of the Medial Femoral Trochlea Osteochondral Free Flap for Proximal Scaphoid Reconstruction

To describe the radiographic, functional, and patient-reported outcomes (PROs) of medial femoral trochlea (MFT) osteochondral free flap reconstruction of the proximal scaphoid at approximately 2 years follow-up. Eleven patients who underwent MFT reconstruction of the proximal scaphoid returned for clinical examination, radiographs, and completion of PROs questionnaires. For another 10 patients who were unable to return, data were gathered remotely or from the medical record. Mean radiographic follow-up was 2.0 years and mean examination follow-up ranged from 2.6 to 2.8 years. Mean follow-up for several PROs ranged from 2.8 to 2.9 years. On average, carpal collapse did not progress, and radiolunate angle was significantly improved by 9.5°. Wrist flexion (41.6°; -6%) and extension (43.8°; -7%) were only slightly changed, and dominance-corrected postoperative pinch and grip strength were 77% and 72% of the uninjured side, respectively. Mean postoperative Disabilities of the Arm, Shoulder, and Hand (DASH) score was 10.7. In patients with both pre- and postoperative scores available, DASH significantly improved by 15 points. Knee donor-site morbidity was measured on the Knee Injury and Osteoarthritis Outcome Score (KOOS)-Sports and Recreation and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scales. The Patient-Reported Outcomes Measurement Information System (PROMIS) Global Health, Physical Function, Pain Intensity, Pain Interference, and Pain Behavior scores reflected good postoperative patient health and function and low pain levels. Higher body mass index (BMI) was found to be predictive of inferior lower extremity and global PROs. An MFT reconstruction of proximal scaphoid nonunion has the potential to restore normal functional radiocarpal anatomy, improve function, and relieve pain without causing wrist stiffness or weakness. Donor-site morbidity has been further delineated in this study. Caution is warranted when considering this procedure in patients with elevated BMI because they may be at increased risk for donor-site morbidity. Therapeutic IV.

Wearable Kinesthetic I/O Device for Sharing Wrist Joint Stiffness.

In this paper, we developed a wearable kinesthetic I/O system, which is able to share wrist joint stiffness by measuring and intervening in four muscle activities on the forearm simultaneously through the same electrodes. This achieves interactive peg rehabilitation by sharing muscle activities among patients and therapists. Through the performance study, it was shown that 1) applied EMS and measured wrist joint stiffness, and 2) produced wrist joint stiffness and measured EMG value has a linear correlation, which allows designing a mapping function between the measured EMG value on one person and the EMS value applied to another person. In a perceptual study, which shared the wrist stiffness between two persons, participants were able to recognize the level of their confederate's wrist joint stiffness using a 4-point Likert scale linearly. The developed system would benefit a physical therapist and a patient for sharing their wrist stiffness and grip force, which are usually difficult to be observed in a visual contact.

High re-operation and complication rates 11 years after arthrodesis of the wrist for non-inflammatory arthritis

Plate and screw fixation has been the standard treatment for painful conditions of the wrist in non-rheumatoid patients in recent decades. We investigated the complications, re-operations, and final outcome in a consecutive series of patients who underwent wrist arthrodesis for non-inflammatory arthritis. A total of 76 patients, including 53 men and 23 women, with a mean age of 50 years (21 to 79) underwent wrist arthrodesis. Complications and re-operations were recorded. At a mean follow-up of 11 years (2 to 18), 63 patients completed questionnaires, and 57 attended for clinical and radiological assessment. Of the 76 patients, 46 (60.5%) had complications, resulting in 65 re-operations, mainly related to the plate and screws. In the 63 patients who completed the questionnaires, the mean Quick Disabilities of Arm, Shoulder and Hand (QuickDASH) score was 36 (0 to 91), the mean Patient-Rated Wrist and Hand Evaluation (PRWHE) score was 40 (0 to 96), and 14 patients (22%) reported no wrist pain. Grip strength, pinch strength, and pronation and supination were significantly reduced compared with the contralateral forearm. The outcome was worse in patients who had previously undergone surgery to the wrist, and those with complications. A total of 13 are awaiting further re-operations, giving a total re-operation rate of 63% (40/63). We observed complications and re-operations throughout the follow-up period and therefore consider wrist arthrodesis to be more complicated than previously assumed. Many of the patients never got used to or accepted their stiff wrists and reported a substantial reduction in function and residual pain. Motion-sparing surgery should be offered prior to wrist arthrodesis. Cite this article: Bone Joint J 2019;101-B:852-859.

External fixation versus plating in intra-articular distal end radius fractures

<p class="abstract"><strong>Background:</strong> Distal end radius fractures are one of the most common encountered fractures in Orthopaedics. Prompt intervention in terms of volar locking plate or external fixation can be performed. The purpose of this study was to derive a better outcome as to which type of fixation is a better choice for the treatment of intra-articular distal end radius fracture.</p><p class="abstract"><strong>Methods:</strong> A prospective randomized controlled study was conducted with 30 patients and comparison was made between the plating and external fixator group using the modified clinical-scoring system of Green and O'Brien and demerit point system at each follow-up.<strong></strong></p><p class="abstract"><strong>Results:</strong> In the plating group 14 patient’s fracture united in 6th week and 1 patient’s fracture united at 8th week this result was similar to the external fixator group were 14 patient’s fracture united in 6th week and 1 patient’s fracture united at 8th week. 1 patient each developed wrist joint stiffness and delayed union in the plating group as compared to the external fixator group were 1 patient each developed wrist joint stiffness, delayed union and broken implant in situ and pin tract infection.</p><p class="abstract"><strong>Conclusions:</strong> During the initial follow ups the functional outcome of the plating group were better than the external fixator group but as the time passed at the final follow up plating was only marginally better than the external fixator group. It was seen that radiologically plating lead to a better correction of all the parameters as compared to external fixator group.</p>

A geometric framework for the estimation of joint stiffness of the human wrist.

Estimating joint stiffness is of paramount importance for studying human motor control and for clinical assessment of neurological diseases. Usually stiffness estimation is performed using cumbersome instrumentations (e.g. robots), and by approximating robot joint angles and torques to the human ones. This paper proposes a methodology and an experimental setup to measure wrist joint stiffness in unstructured environments, with the twofold aim of: 1) providing a geometric framework in order to derive angular displacements and torques at the wrist Flexion/Extension (FE) and Radial/Ulnar Deviation (RUD) axes of rotation, using a subject specific kinematic model; 2) suggesting an experimental setup made of two portable sensors for motion tracking and one load cell, to allow for measurements in out-of-the-lab scenarios. We tested our method on a hardware mockup of wrist kinematics, providing a ground truth for estimated angles and torques at FE and RUD joints. The experimental validation showed average absolute errors in FE and RUD angles of 0.005 rad and 0.0167 rad respectively, and an average error of FE and RUD torques of 0.006 Nm and 0.003 Nm.

The Impact of Aging and Hand Dominance on the Passive Wrist Stiffness of Squash Players: Pilot Study

Background: Passive joint stiffness can influence the risk of injury and the ability to participate in sports and activities of daily living. However, little is known about how passive joint stiffness changes over time with intensive repetitive exercise, particularly when performing unilateral activities using the dominant upper limb.

Volar Approach to Percutaneous Fixation of Acute Nondisplaced Fractures of the Scaphoid.

Scaphoid fractures typically occur in young, healthy males at the peak of their employment and productivity, and left untreated or inadequately treated will ultimately progress to nonunion and a "predictable" pattern of wrist arthritis and carpal collapse. Nonoperative treatment of these fractures requires prolonged cast immobilization, which can lead to wrist stiffness, loss of grip strength, muscle atrophy, and protracted loss of economic productivity. To prevent these devastating sequelae, percutaneous techniques for scaphoid fixation have been described and popularized; however, these techniques are technically demanding as optimal position of the compression screw is required to achieve bony union. The focus of this paper is to describe the indications, contraindications, and a series of reproducible, practical pearls to achieve ideal percutaneous scaphoid compression screw fixation of scaphoid waist and distal pole fractures.

Model-Based Analysis of the Stiffness of the Wrist Joint in Active and Passive Conditions

The control of joint stiffness is a fundamental mechanism used to control human movements. While many studies have observed how stiffness is modulated for tasks involving shoulder and elbow motion, a limited amount of knowledge is available for wrist movements, though the wrist plays a crucial role in manipulation. We have developed a computational framework based on a realistic musculoskeletal model, which allows one to calculate the passive and active components of the wrist joint stiffness. We first used the framework to validate the musculoskeletal model against experimental measurements of the wrist joint stiffness, and then to study the contribution of different muscle groups to the passive joint stiffness. We finally used the framework to study the effect of muscle cocontraction on the active joint stiffness. The results show that thumb and finger muscles play a crucial role in determining the passive wrist joint stiffness: in the neutral posture, the direction of maximum stiffness aligns with the experimental measurements, and the magnitude increases by 113% when they are included. Moreover, the analysis of the controllability of joint stiffness showed that muscle cocontraction positively correlates with the stiffness magnitude and negatively correlates with the variability of the stiffness orientation (p < 0.01 in both cases). Finally, an exhaustive search showed that with appropriate selection of a muscle activation strategy, the joint stiffness orientation can be arbitrarily modulated. This observation suggests the absence of biomechanical constraints on the controllability of the orientation of the wrist joint stiffness.

The influence of simultaneous handgrip and wrist force on forearm muscle activity

The purpose of this study was to examine forearm muscle activity during simultaneous execution of dual motor tasks; hand-gripping and wrist forces. Surface electromyography was recorded from eight muscles of the upper-limb: flexor carpi radialis, flexor carpi ulnaris, flexor digitorum superficialis, extensor carpi radialis, extensor carpi ulnaris, extensor digitorum, biceps brachii and triceps brachii. Participants were seated with their forearm supported in a neutral position with an adjustable force transducer placed on either the palmar or dorsal side of the hand (for palmar/dorsal forces). Participants performed trials of simultaneous handgrip and wrist forces of various magnitudes, ranging in intensity from 0 to 40% of their maximal voluntary contraction. Trials lasted 5 s and force and electromyography data were assessed. The wrist flexors provided greatest contributions to tasks dominated by palmar forces but exhibited very low muscle activity in dorsal dominant tasks. Wrist extensors were active at moderate-to-high levels across nearly all conditions and demonstrated greater activity than the wrist flexors during handgrip-dominant tasks. These findings suggest that the wrist extensors provide the greatest contribution to wrist stiffness in complex motor tasks, and highlight the importance of investigating forearm muscle recruitment strategies under dual task parameters.

Smoking Increases Postoperative Complications After Distal Radius Fracture Fixation: A Review of 417 Patients From a Level 1 Trauma Center.

Background: Unstable distal radius fractures that undergo surgical stabilization have varying complication rates in the literature. Smoking is known to affect bone healing and implant fixation rates but has never been definitively shown to affect postoperative outcomes of surgically managed distal radius fractures. Methods: A retrospective review was performed of patients with surgically treated distal radius fractures at a Level 1 Trauma Center who had at least 6 weeks of follow-up over a 5-year period. Charts were reviewed for basic demographic information, comorbidities, details about the operative procedure, and early complications. Notable physical examination findings were noted, such as wrist stiffness and distal radius tenderness to palpation. Statistical analysis was performed to compare the smoking and nonsmoking groups. To control for confounding differences, a hierarchical multivariable regression analysis was performed. Results: Four hundred seventeen patients were included in the study, and 24.6% were current smokers at the time of surgery. The overall complication rate for smokers was 9.8% compared with 5.6% in nonsmokers. The smoking cohort showed significantly higher rates of hardware removal, nonunion, revision procedures, wrist stiffness, and distal radius tenderness. When controlling for the confounding variables of diabetes and obesity, smokers still had significantly higher rates of the same complications. Conclusion: Patients who smoke have a statistically significant higher rate of postoperative distal radius tenderness, wrist stiffness, nonunion, hardware removal, and revision procedures compared with those who do not smoke in a review of 417 total patients undergoing surgical fixation for distal radius fractures.

Operative Treatment of Intra-Articular Distal Radius Fractures With Versus Without Arthroscopy: A Randomized Controlled Trial RADAR-trial

There is no financial information to disclose. The past several years, an increase in open reduction internal fixation (ORIF) for intra-articular distal radius fractures has been observed. This technique leads to a quicker recovery of function compared with nonsurgical treatment. However, some patients continue to have a painful and stiff wrist postoperatively. Arthroscopically assisted removal of intra-articular fracture hematoma and debris may improve the functional outcomes following operative treatment of intra-articular distal radius fractures. The purpose of this randomized controlled trial is to determine the difference in functional outcome, assessed with the Patient-Rated Wrist Evaluation (PRWE) score, after ORIF with and without an additional wrist arthroscopy in adult patients with displaced complete articular distal radius fractures. In this multicenter trial, adult patients with a displaced complete articular distal radius fracture were randomized between ORIF with an additional wrist arthroscopy to remove fracture hematoma and debris (intervention group) and conventional fluoroscopic assisted ORIF (control group). The primary outcome was functional outcome assessed with the PRWE score after 3 months. Secondary outcomes were wrist function assessed with the Disability of the Arm, Shoulder and Hand (DASH) score, postoperative pain, range of motion, grip strength, complications, and cost-effectiveness. Additionally, in the intervention group the quality of reduction, associated ligamentous injuries and cartilage damage were assessed. A total of 50 patients were included in this study. A total of 50 patients were randomized, 25 to the intervention group and 25 to the control group. All patients who had arthroscopic treatment had a hematoma, which was removed. Other arthroscopic findings were: TFCC injury in 91%, scapholunate injury in 50%, lunotriquetral injury in 50%, damage of the fossa lunata in 68%, and damage of the fossa schapoidea in 55%. Mean PRWE was not significantly better for the intervention group at 3 weeks (49 [28–66] vs 59 [49–66], P = .08), and at 6 weeks (41 [20–58] vs 38 [29–45], P = .61). Mean PRWE was significantly worse for the intervention group at 3 months (30 [8.2–46] vs 14 [5–21], P = .01). •Patients treated with additional arthroscopy to remove hematoma and debris do not have better functional outcomes compared with the non–arthroscopically treated group.

Passive Wrist Stiffness: The Influence of Handedness.

This paper reports on the quantification of passive wrist joint stiffness and investigates the potential influence of handedness and gender on stiffness estimates. We evaluated the torque-angle relationship during passive wrist movements in 2 degrees of freedom (into flexion-extension and radial-ulnar deviation) in 13 healthy subjects using a wrist robot. Experimental results determined intrasubject differences between dominant and nondominant wrist and intersubject differences between male and female participants. We found differences in the magnitude of passive stiffness of left- and right-hand dominant males and right-hand dominant females suggesting that the dominant hand tends to be stiffer than the nondominant hand. Left-hand stiffness magnitude was found to be 37% higher than the right-hand stiffness magnitude in the left-handed male group and the right-hand stiffness magnitude was 11% and 40% higher in the right-handed male and female groups, respectively. Other joint stiffness features such as the orientation and the anisotropy of wrist stiffness followed the expected pattern from previous studies. The observed difference in wrist stiffness between the dominant and nondominant limb is likely due to biomechanical adaptations to repetitive asymmetric activities (such as squash, tennis, basketball, or activities of daily living such as writing, teeth brushing, etc.). Understanding and quantifying handedness influence on stiffness may have critical implication for the optimization of surgical and rehabilitative interventions.

Compliant Prosthetic Wrists Entail More Natural Use Than Stiff Wrists During Reaching, Not (Necessarily) During Manipulation.

Developing an artificial arm with functions equivalent to those of the human arm is one of the challenging goals of bioengineering. State-of-the-artprostheses lack several degrees of freedom and force the individuals to compensate for them by means of compensatory movements, which often result in residual limb pain and overuse syndromes. Passive wristsmay reduce such compensatory actions, nonethelessto date their actual efficacy, associated to conventional myoelectric hands is a matter of debate. We hypothesized that a transradial prosthesiswould allow a simpler operation if its wrist behaved compliant during the reaching and grasping phase, and stiff during the holding andmanipulation phase. To assess this, we compared a stiff and a compliant wrist and evaluating the extent of compensatory movements in the trunk and shoulder, with unimpaired subjects wearing orthoses, while performing nine activities of daily living taken from the southampton hand assessment procedure. Our findings show indeed that the optimal compliance for a prosthetic wrist is specific to the phase of the motor task: the compliant wrist outperforms the stiff wrist during the reaching phase, whereas the stiff wrist exhibits more natural movements during the manipulation phase of heavy objects. Hence, this paper invites rehabilitation engineers to develop wrists with switchable compliance.

Management of intra articular fractures of distal radius with variable angled locking compression plate -midterm outcome analysis

Introduction: Fractures of distal radius remains one of the most challenging fractures treated by orthopaedic surgeons. The aim of this study is to analyse the functional outcome in intra articular distal radius fractures treated with variable angled volar locking plate. Aim of the Study: The aim of this study is to analyse the functional outcome in intra articular distal radius fractures treated with variable angled volar locking plate.Materials and Methods: From May 2016 to November 2017, consecutive patients with intra articular distal radius fractures were included in the study. All subjects were recruited, operated, and assessed at Department of Orthopaedic Surgery, RMMCH, Annamalai University, Chidambaram, Tamilnadu. The patients were followed up for a minimum of 6 months. The results were evaluated using Gartland and Werley scoring system for wrist.Results: Of the forty wrists operated, according to demerit system of Gartland and Werley, 25 cases were males and 15 cases were females of which 28 cases were right and 12 cases were left wrists, the most common mode of injury being fall on out stretched hand accounting for 80% of cases, the average time for surgery was 5 days from the date of admission, a below elbow slab was applied on the day of admission till surgery. Excellent to Good results were obtained in 38 wrists i.e. 95%. Fair results were obtained in two wrists (5%). None of the patient showed poor results. Two patients showing fair results had wrist stiffness mainly attributable to patient’s noncompliance to Physiotherapy. No major complication was noted in our study.Conclusion: Variable angled volar locking plate is the implant of choice in Comminuted Intraarticular distal radius Fractures. Use of locked variable angled plate predictably yields better patient reported outcome as per Gartland and Werley scoring system and allows earlier range of wrist motion which yields accelerated return of function necessary for our Indian population.