BACKGROUND: The best treatment for an inadequately reduced fracture
of the distal part of the radius is not well established. We collected
prospective outcomes data for patients undergoing open reduction and internal
fixation of an inadequately reduced distal radial fracture with use of the
volar locking plating system.
METHODS: Over a two-year period, 161 patients underwent open
reduction and internal fixation of an inadequately reduced distal radial
fracture with use of the volar locking plating system. Patients were enrolled
in the present study three months after the fracture on the basis of strict
entry criteria and were evaluated three, six, and twelve months after surgery.
Outcome measures included radiographic parameters, grip strength, lateral
pinch strength, the Jebsen-Taylor test, wrist range of motion, and the
Michigan Hand Outcomes Questionnaire.
RESULTS: Eighty-seven patients with a distal radial fracture were
enrolled. The mean age at the time of enrollment was 48.9 years. Forty percent
(thirty-five) of the eighty-seven fractures were classified as AO type A, 9%
(eight) were classified as type B, and 51% (forty-four) were classified as
type C. Radiographic assessment showed that the plating system maintained
anatomic reduction at the follow-up periods. At the time of the twelve-month
follow-up, the mean grip strength on the injured side was worse than that on
the contralateral side (18 compared with 21 kg; p < 0.01), the mean pinch
strength on the injured side was not significantly different from that on the
contralateral side (8.7 compared with 8.9 kg; p = 0.27), and the mean flexion
of the wrist on the injured side was 86% of that on the contralateral side.
All Michigan Hand Outcomes Questionnaire domains approached normal scores at
six months, with small continued improvement to one year.
CONCLUSIONS: The volar locking plating system appears to provide
effective fixation when used for the treatment of initially inadequately
reduced distal radial fractures.
LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions
to Authors for a complete description of levels of evidence.
ORIGINAL ABSTRACT CITATION: "Treatment of Unstable Distal Radial
Fractures with the Volar Locking Plating System"