Surgical Management of Unstable Distal Radius Fractures with a Variable-Angle Volar Locking Plate

*Ahmed Mohamed Abdel Wahed
Department Of Orthopedic Surgery, Zagazig University, Egypt

*Corresponding Author:
Ahmed Mohamed Abdel Wahed
Department Of Orthopedic Surgery, Zagazig University, Egypt

Published on: 2020-05-25

Abstract

Background: The distal radius is one of the most commonly fractured bones in the body accounting for 8 - 15% of all broken bones. The use of variable-angle locking plates is promoted for the management of these fractures. This study aimed to evaluate the radiological and clinical outcome of the management of unstable distal radius fractures using a variable-angle volar locking plate.
Methods: This was performed a prospective cohort study on 18 patients with unstable distal end radius fractures, admitted to Orthopedic Department in Zagazig University Hospital and El-Menshawy General Hospital in Tanta. All patients were operated from January 2019 to June 2019. The affected patients’ age ranged from 24 to 65 years old with a mean of (37.06 ± 12.69). There were 12 males and 6 females. These fractures were treated by internal fixation (ORIF) using the variable angle 2.4-mm distal radius locking plate.
Results: There was one patient had a tourniquet palsy which was resolved after one month of physiotherapy (5.56%). One patient suffered from delayed wound healing (5.56%). One patient had screw misplacement in the radio-ulnar joint that remains asymptomatic at the final follow up period (5.56%). At the end of follow up period, inclination angle (frontal tilt) ranged from 17° to 24° (mean was 20.36° ± 2.53), volar (sagittal) tilt ranged from 7° to 14° (mean was 10.32° ± 2.26). According to the disabilities of arm, shoulder, and hand scoring system (DASH score), 8 patients (44.44%) had excellent results with an average 3.55 ± 1.24, 8 patients (44.44%) had good results with average 9.70 ± 1.98. There was a statistically highly significant correlation between the radiological outcome and final clinical score.
Conclusions: The use of variable-angle locking plates in treating unstable distal end radius fractures is associated with excellent to good functional outcomes with a significant reduction of hardware complication.

Keywords

Distal Radius; Variable Angle; Locking Plate; Volar; Internal Fixation

Introduction

The distal radius is one of the most commonly fractured bones in the body accounting for 8-15% of all broken bones [1]. Such fractures mainly affect the elderly population and they involve low energy trauma. However, in young adults, high-energy trauma such as that resulting from vehicular traffic accidents accounts for a substantial number of cases [2], which present as shear and impacted fractures of the articular surface of the distal radius with the displacement of the fragments [3].
Certainly, the new low profile plates and locking systems have popularized the surgical option. Treatment modalities exist for surgical management of these fractures, including open reduction and internal fixation (ORIF) with volar or dorsal plates and screws, non-spanning external fixation (NSEF), closed reduction and percutaneous pinning (CRPP), spanning external fixators or a variation of each [4].
Restoration of volar angulation, radial length, and radial inclination are essential for good functional outcomes at the wrist joint. Maintenance of articular congruity and stable fixation reduce the incidence of osteoarthritis and help for earlier rehabilitation [5].

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