Management of distal unstable radius fractures with volar locking plates: A retrospective cohort study

Abstract

Aim: Unstable distal radius fractures are difficult to manage. Volar locking plate screw is a better option than the other treatment methods (external fixator, K pin, etc.). The aim of this study is to present the radiographic and functional clinical results of patients with lower end unstable radius fractures who were treated with volar locking plate screws in our clinic.
Methods: A total of 52 patients (29 males, 23 females, mean age 42; the distribution 18-77) who underwent volar locking plate fixation due to an unstable distal radial end fracture were examined. Based on the AO classification, six patients (11.5%) had B2, five patients (9.6%) had B3, four patients (7.6%) had C1, 29 patients (55.7%) had C2 and 8 patients had (15.3%) C3 fractures. Twenty-one (77.8%) of the fractures had dorsal angulation, while six (22.2%) had volar angulation. The fracture was accompanied by an elbow dislocation and/or fracture in four patients (14.8%). Eleven patients (21.1%) had distal radioulnar joint problems. In fifteen patients (28.8%), autogenous crista iliac graft was used in addition to fracture fixation. The patients’ range of motion and grip strength were measured. Evaluations were made according to the Stewart criteria. In the functional evaluation, the Quick-DASH-T (Disabilities of the Arm, Shoulder and Hand-Turkish) questionnaire and the Gartland-Werley evaluation form were used. The average duration of follow-up was 15 months (range: 12-34 months).
Results: All bones healed smoothly in approximately 7 weeks (range: 6-8 weeks). The average radiographic score was 0.5 (0-3) in the Stewart rating scale. The ulnar variance value was approximately -0.4 (between 0 and -2.5 mm) in 30 patients (57.6%). The average positive ulnar variance level was 0.5 mm (between 0-2.5 mm) in 12 patients (23%). A neutral variance level occurred in ten patients (19.2%). In 32 patients (61.5%) whose radial inclination angles were not equalized, the intact side was 28.5° (the interval 21°-30°) while the average angle for the side that underwent surgery was 22.3° (the interval 18°-27°). The radial inclination angle of fifteen patients (28.8%) gradually equaled the intact side. In other patients, the average radial inclination angle was 5.9° towards the volar direction (dorsal 2°- volar 13°) on the intact side. In twenty-five patients (48%), the loss of radial height was 1.3 mm (0-5 mm) on the side that underwent surgery. The grip strength of the side treated was approximately 69% (18 kg) of the intact side. The average Quick-DASH-T score was found as 8.3 (the distribution being 0-70.5), and the average Gartland-Werley score was found as 4.7 (the distribution 0-16). According to the Gartland-Werley evaluation, the results were excellent in 25 patients (48%), good in 25 (48%) and moderate in 3 (4%).
Conclusion: Volar locking plate applications are efficient in correcting and protecting the distal radius end anatomy.