Abstract
Aim To evaluate the outcome of these complex fractures using a volar approach and the
DePuy Synthes variable-angle 2.4-mm distal radius rim plate. This plate is precontoured
to the volar rim for placement distal to the watershed line allowing purchase of the
rim fragment of the lunate facet. Its low profile and smooth edges are designed to
minimize flexor tendon irritation.
Method We report on a consecutive series of far distal AO-23B3 and AO-23C3 fractures treated
using this plate in a tertiary hand center between November 2011 and May 2014. Range
of motion, grip strength, and complications were assessed at the final clinical review.
Disabilities of the arm, shoulder, and hand (DASH) and patient evaluation measure
(PEM) scores were assessed at 12 months after surgery.
Results Twenty-six patients were included in this review. Six patients were lost to follow-up
at 3 months. This plate was used in isolation in 17 cases, and in combination with
a dorsal plate, in cases of dorsal instability after volar plating, in 10 patients.
DASH and PEM scores 1 year after surgery were 17.6 and 27%, respectively. Visual analog
scores for patient treatment satisfaction and severity of pain showed good satisfaction
with treatment and mild intermittent pain on activity. Postoperative range of motion
was variable and grip strength was of 71% of the uninjured contralateral side. There
were no cases of flexor or extensor tendon rupture. Tendon irritation was noted in
two patients. Removal of metal was performed in four patients. Loss of reduction occurred
in one case and neurologic complications in two cases.
Conclusion This implant is specifically designed for the management of far distal complex intra-articular
fractures of the distal radius. Despite the complexity of these fracture patterns
and the challenge they pose to accurate reduction and stable fixation, outcomes were
satisfactory in this small series. There were no cases of tendon rupture. Removal
of metal is not necessary in all cases, but prompt removal should be performed in
cases of tendon irritation in view of the risk of tendon rupture.
Keywords
distal radius fracture - open reduction and internal fixation - patient evaluation
measure - variable-angle distal radius rim plate
