Volar Plating for Displaced Fractures of the Distal Radius

Abstract

Purpose: The aim of this project was to study the functional outcome of displaced distal radius fractures treated with the use of a locking volar plate. Methods: Twenty-five consecutive patients with displaced distal radius fractures were treated with open reduction and internal fixation, using the volar locking AO plate. Bone grafting was used in 9 cases. Postoperative evaluation included radiographic assessment and range of motion of the affected wrists. Controlled passive and active motion exercises were initiated on the seventh postoperative day. Functional outcomes were evaluated with use of the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and the Gartland and Werley scoring system. Results: The mean follow-up was 18 months. There was no failure of fixation or loss of the reduction. Thirteen of fifteen patients with intra-articular fractures had good or excellent results, while 9 of 10 patients with extra-articular fractures had excellent results. The mean score on the DASH questionnaire was 14 points. Ranges of motion in intra-articular fractures were measured as 58° for wrist extension, 70° for flexion, 70° for pronation and 65° for supination, while for extra-articular fractures they were 75° extension, 78° flexion, 82° pronation and 78° supination. Conclusions: Treatment of distal radius fractures through a volar approach using the AO volar plate appears to be effective. This technique restores the anatomy of the distal radius predictably, allowing a safe and early range of motion.

Key words

Distal radius - fracture - open reduction - plate fixation

References

• 1 Axelrod T S, McMurty R Y. Open reduction and internal fixation of comminuted, intraarticular fractures of the distal radius.  J Hand Surg [Am]. 1990;  15 1-11
• 2 Campbell D A. Open reduction and internal fixation of intraarticular and unstable fractures of the distal radius using the AO distal radius plate.  J Hand Surg [Br]. 2000;  25 528-534
• 3 Carter P R, Frederic H A, Laseter G F. Open reduction and internal fixation of unstable distal radius fractures with a low-profile plate: a multicenter study of 73 fractures.  J Hand Surg [Am]. 1998;  23 300-307
• 4 Cooney  III W P, Linscheid R L, Dobyns J H. External pin fixation for unstable colles fractures.  J Bone Joint Surg [Am]. 1980;  62 613-619
• 5 Dias J J, Wray C C, Jones J M, Gregg P J. The value of early mobilization in the treatment of colles fractures.  J Bone Joint Surg [Am]. 1987;  69 463-467
• 6 Edwards G S. Intra-articular fractures of the distal part of the radius treated with the small AO external fixator.  J Bone Joint Surg [Am]. 1991;  73 1241-1250
• 7 Fernandez D L, Geissler W B. Treatment of displaced articular fractures of the radius.  J Hand Surg [Am]. 1991;  16 375-384
• 8 Fernandez D L. Should anatomic reduction be pursued in distal radial fractures?.  J Hand Surg [Br]. 2000;  25 1-6
• 9 Fitoussi F, Ip W Y, Chow S P. Treatment of displaced intra-articular fractures of the distal end of the radius with plates.  J Bone Joint Surg [Am]. 1997;  79 1303-1312
• 10 Frykman G K, Tooma G S, Boyko K, Henderson R. Comparison of eleven external fixators for treatment of unstable wrist fractures.  J Hand Surg [Am]. 1989;  14 247-254
• 11 Gartland Jr  J J, Werley C W. Evaluation of healed Colles' fractures.  J Bone Joint Surg [Am]. 1951;  33 895-907
• 12 Gretting M D, Bishop A T. Intrafocal (Kapandji) pinning of unstable fractures of the distal radius.  Orthop Clin North Am. 1993;  24 301-307
• 13 Hudak P L, Amadio P C, Bombardier C. Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder, and hand) (corrected). The Upper Extremity Collaborative Group (UECG).  Am J Ind Med. 1996;  29 602-608
• 14 Jupiter J B, Lipton H. The operative treatment of intraarticular fractures of the distal radius.  Clin Orthop. 1993;  292 48-61
• 15 Kaempffe F A, Wheeler D R, Peimer C A, Hvisdak K S, Ceravolo J, Senall J. Severe fractures of the distal radius: effect of the amount and duration of external fixator distraction on outcome.  J Hand Surg [Am]. 1993;  18 33-41
• 16 Kamano M, Honda Y, Kazuki K, Yasuda M. Palmar plating for dorsally displaced fractures of the distal radius.  Clin Orthop. 2002;  397 403-408
• 17 Kambouroglou G K, Axelrod T S. Complications of the AO / ASIF titanium distal radius plate system (π plate) in internal fixation of the distal radius: a brief report.  J Hand Surg [Am]. 1998;  23 737-741
• 18 Knirk J L, Jupiter J B. Intraarticular fractures of the distal end of the radius in young adults.  J Bone Joint Surg [Am]. 1986;  68 647-659
• 19 Lee H C, Wong Y S, Chan B K, Low C O. Fixation of distal radius fractures using AO titanium volar distal radius plate.  Hand Surg. 2003;  8 7-15
• 20 Liporace F A, Gupta S, Jeong G K, Stracher M, Kummer F, Egol K A, Koval K J. A biomechanical comparison of a dorsal 3.5-mm T-plate and a volar fixed-angle plate in a model of dorsally unstable distal radius fractures.  J Orthop Trauma. 2005;  19 187-191
• 21 McQueen M, Caspers J. Colles fracture: does the anatomical result affect the final function?.  J Bone Joint Surg [Br]. 1988;  70 649-651
• 22 Muller M E, Nazarais S, Koch P, Schatzker J. The Comprehensive Classification of Fractures of Long Bones. Springer, New York 1990
• 23 Orbay L J, Fernandez D L. Volar fixation for dorsally displaced fractures of the distal radius: A preliminary result.  J Hand Surg [Am]. 2002;  27 205-215
• 24 Orbay L J, Fernandez D L. Volar fixed-angle plate fixation for unstable distal radius fractures in the elderly patient.  J Hand Surg [Am]. 2004;  29 96-102
• 25 Osada D, Fujita S, Tamai K, Iwamoto A, Tomizawa K, Saotome K. Biomechanics in uniaxial compression of three distal radius volar plates.  J Hand Surg [Am]. 2004;  29 446-451
• 26 Penning D, Gausepohl T. External fixation of the wrist.  Injury. 1996;  27 1-15
• 27 Rickli D A, Regazzoni P. Fractures of the distal end of the radius treated by internal fixation and early function.  J Bone Joint Surg [Br]. 1996;  78 588-592
• 28 Stewart H D, Innes A R, Burke F D. The hand complications of Colles fracture.  J Hand Surg [Br]. 1985;  10 103-106
• 29 Stoffelen D, De Smet L, Broos P. The importance of the distal radioulnar joint in distal radial fractures.  J Hand Surg [Br]. 1998;  23 507-511
• 30 Trumble T E, Schmitt S R, Vedder B. Factors affecting functional outcome of displaced intraarticular distal radius fractures.  J Hand Surg [Am]. 1994;  19 325-340
• 31 Weber S C, Szabo R M. Severly comminuted distal radius fracture as an unsolved problem: complications associated with external fixation and pins and plaster techniques.  J Hand Surg [Am]. 1986;  11 157-165
• 32 Wright T W, Horodyski M, Smith D W. Functional outcome of unstable distal radius fractures: ORIF with a volar fixed-angle tine plate versus external fixation.  J Hand Surg [Am]. 2005;  30 289-299