Volar Locking Plate for Distal Radius Fractures: Functional Outcomes and Complication Rates with a Minimum of One Year Follow-Up

Distal radius fractures (DRF) are the most common type of fractures of the upper extremities with an incidence of 44% of all types of forearm and hand fractures. In unstable DRF, the aim of surgical treatment is to restore a functional wrist. Volar locking plate is supported in literature as a promising surgical method in treatment of these fractures. The aim of this study is to analyze the type and complication rate with applied volar locking plate, the percentage of revision surgery and the functional outcomes in a minimum of one year follow up. Material &Methods: 104 fractures in 98 patients with a mean range of 48,5 years-old age underwent for unstable distal radius fractures with volar locking plate. The main cause was simple fall to an outstretched hand. In ten cases the fracture was open while in 28 cases the DRF was accompanied with ulnar styloid. All fractures classified by AO/OTA in A2-3 27 cases, B1-3 in 45 and C1-3 in 32 cases. The majority of patients were operated within 48-72 hours after injury. In all cases an extended flexor carpi radialis approach was performed and a volar locking plate was applied in all DRF’s. In sixteen cases with base of ulnar styloid fractures, low profile locking plates were applied, while in the rest of patients Kirschner wires were used. Postoperatively all patients followed a standard protocol rehabilitation program with passive and active motion of fingers and wrist. Results: Patients were evaluated according to complication (type and rate), time to fracture union, range of motion, Visual analogue pain scale, Quick Dash Score and patients-rated wrist evaluation score. Complications were distinguished in major and minor. Patients under 60 years-old with type fracture A2-3 and B1-3 showed better range of motion and grip strength than patients over 65 years old. In cases with type fractures C1-3 and age over 65 years old, ROM and grip strength decreased compared with the unilateral side. The percentage of complication and reoperation appeared more increased in type C1-3 related to the other two types of fractures. Finally the mean Quick DASH was 11,1±12,8, RPWE was 9.8±13,6 and the range of motion was in extension 75,2±7,3, in flexion 74±8,9, in pronation 85,6±1,9, in supination 88,5±2,4 in radial deviation 9,8±1,2 and in ulnar deviation 41,1±4,6 and grip strength was an average of 84,7% of uninjured hand. Conclusion: Unstable fractures required operative treatment with volar locking plate to be the gold standard in recently years. Unfortunately VPL presents postoperative complications related with plate and screw position with comminuted fracture or soft tissue damage which cannot be ignored, and for these reasons may be inadequate for all types of distal radius fractures.

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Mid-Term Functional Outcome after Volar Locking Plate Fixation of Distal Radius Fractures in Elderly Patients

The Journal of Hand Surgery (Asian-Pacific Volume) ◽

10.1142/s2424835518500273 ◽

2018 ◽

Vol 23 (02) ◽

pp. 238-242 ◽

Cited By ~ 3

Author(s):

Haruhiko Shimura ◽

Akimoto Nimura ◽

Koji Fujita ◽

Takashi Miyamoto

Keyword(s):

Elderly Patients ◽

Range Of Motion ◽

Grip Strength ◽

Distal Radius ◽

Locking Plate ◽

Distal Radius Fractures ◽

Volar Locking Plate ◽

Radius Fractures ◽

Significant Difference

Background: The volar locking plate is frequently used in the fixation of unstable distal radius fractures, but despite this there is a paucity of mid to long term outcome studies. The purpose of this study was to investigate the mid-term functional outcomes of elderly patients treated with a volar locking plate for unstable distal radius fractures. Methods: Thirty-two patients with a mean age of 74.1 (range, 65–85) years were followed for a mean of 39.1 (range, 30–81) months. Patients with follow-up periods of < 24 months were excluded from this study to investigate the mid-term clinical outcomes. The Mayo wrist score (MWS), grip strength and wrist range of motion were retrospectively reviewed at 12 months, 24 months and the latest follow-up (mean 39.1 months). Osteoarthritis status according to the system of Knirk and Jupiter was assessed at 24 months. Results: Significant improvements in MWS and grip strength were observed between 12 and 24 months but not between 24 months and the final follow-up. There was no significant difference in wrist range of motion between 12 and 24 months. The MWS of 14 patients with radiographic signs of osteoarthritis was not significantly different from that of 18 patients without radiographic signs of osteoarthritis. Conclusions: Elderly patients treated with the volar locking plate showed improved MWS and grip strength postoperatively after 12 months. Improvement in grip strength was slower than range of motion.

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Recovery of Wrist Function after Volar Locking Plate Fixation for Distal Radius Fractures

The Journal of Hand Surgery (Asian-Pacific Volume) ◽

10.1142/s2424835516500193 ◽

2016 ◽

Vol 21 (02) ◽

pp. 199-206 ◽

Cited By ~ 2

Author(s):

Naohide Takeuchi ◽

Shunsuke Hotokezaka ◽

Takamitsu Okada ◽

Hidehiko Yuge ◽

Takao Mae ◽

...

Keyword(s):

Range Of Motion ◽

Grip Strength ◽

Distal Radius ◽

Locking Plate ◽

Distal Radius Fractures ◽

Dominant Hand ◽

Volar Locking Plate ◽

Radius Fractures ◽

Wrist Function ◽

One Year

Background: The purpose of our present study was to examine the recovery of the postoperative wrist function, and to compare the range of motion among each direction ofthe wrist joint during the same time periods after surgery for distal radius fractures.Methods: Twenty patients treated with a volar locking plate were evaluated. The active range of motion and grip strength were assessed at four weeks, six weeks, three months, six months and one year after surgery.Results: The ratio of the range of motion in pronation and supination recovered significantly earlier than for any other directions within six months after surgery (p = 0.0205), however, the ratio of the range of motion among the six directions was not significantly different at one year after surgery (p = 0.0823). The recovery of the range of motion in flexion was 96.8% compared with the contralateral wrist at one year after surgery, and it was not significantly lower than that in extension, radial deviation or ulnar deviation (97.8%, 93.5%, 94.4%, respectively). The grip strength of dominant hand recovered from 50% after four weeks to 66% after six weeks, 83% after three months, 91% after six months and 106% at the examination performed after one year compared with the uninjured non-dominant hand. The grip strength of non-dominant hand recovered from 52% after four weeks to 59% after six weeks, 79% after three months, 84% after six months and 94% at the examination performed after one year compared with the uninjured dominant hand. The mean DASH score was 5.3.Conclusions: The range of motion in flexion can achieve similar improvement to that in the other directions by obtaining the appropriate postoperative parameters. The optimal postoperative radiographic parameters were thus identified to be essential for successfully obtaining a recovery of the wrist function for unstable distal radius fractures.

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Evaluation of Patient-Reported and Clinician-Reported Outcomes of Volar Locking Plate Fixation for Distal Radius Fractures

The Journal of Hand Surgery (Asian-Pacific Volume) ◽

10.1142/s2424835520500411 ◽

2020 ◽

Vol 25 (03) ◽

pp. 359-363

Author(s):

Nana Nagura ◽

Kiyohito Naito ◽

Yoichi Sugiyama ◽

Hiroyuki Obata ◽

Kenji Goto ◽

...

Keyword(s):

Range Of Motion ◽

Distal Radius ◽

Clinical Evaluation ◽

Locking Plate ◽

Distal Radius Fractures ◽

Dash Score ◽

Volar Locking Plate ◽

Radius Fractures ◽

Patient Reported

Background: Postoperative evaluation of wrist joint trauma is divided into patient-reported outcomes (PROs) and clinician-reported outcomes (CROs). We investigated the association of the Q-DASH score as the postoperative PROs and the Mayo wrist score as the postoperative CROs with clinical evaluation in patients with distal radius fractures surgically treated using a volar locking plate (VLP). Moreover, whether PROs and CROs are correlated to the clinical evaluation was investigated. Methods: The subjects were 109 patients surgically treated for distal radius fractures at our hospital between June 2013 and May 2017. Forty-one patients were male, 68 patients were female, and the mean age was 61.4 (19–86) years old. The fracture type was AO classification A type in 30 patients (A2: 25, A3: 5), B type in 5 (B2: 1, B3: 4), and C type in 74 (C1: 50, C2: 11, C3: 13). All patients were surgically treated using VLP. The range of motion of the wrist, grip strength the Visual Analog Scale (VAS), the Q-DASH score (PROs), and the Mayo wrist score (CROs) were investigated. Each evaluation was compared as the clinical outcome between at 3 months after surgery and the final follow-up. In addition, the correlations of the postoperative PROs and CROs with the clinical evaluation were analyzed. Results: Each evaluation was significantly improved compared with that at 3 months after surgery. There was a significant correlation between PROs and CROs at 3 months after surgery and the final follow-up. However, the range of motion of the wrists was not significantly correlated with PROs or CROs at 3 months after surgery or at the final follow-up. Conclusions: On evaluation after surgery for distal radius fractures, PROs and CROs improved early after surgery (3 months after surgery) before the final follow-up, and an inverse correlation was present between these scores.

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Comparison of Five Years Clinical and Radiological Outcomes between Progressive and Non-Progressive Wrist Osteoarthritis after Volar Locking Plate Fixation of Distal Radius Fractures

The Journal of Hand Surgery (Asian-Pacific Volume) ◽

10.1142/s2424835519500061 ◽

2019 ◽

Vol 24 (01) ◽

pp. 30-35 ◽

Cited By ~ 1

Author(s):

Takeshi Katayama ◽

Hiroshi Ono ◽

Shohei Omokawa

Keyword(s):

Clinical Outcomes ◽

Distal Radius ◽

Locking Plate ◽

Plate Fixation ◽

Distal Radius Fractures ◽

Volar Locking Plate ◽

Wrist Flexion ◽

Radius Fractures ◽

Locking Plate Fixation

Background: This study aimed to identify the effect of the progression of postoperative wrist osteoarthritis on 5 years clinical and radiological outcomes after volar locking plate fixation of distal radius fractures. Methods: Altogether, 56 patients with distal radius fractures were followed up 5 years after surgery. Clinical assessment was performed using the Mayo modified wrist score, a visual analogue scale of pain, the Japanese version of the Disabilities of the Arm, Shoulder, and Hand score, and Patient-related wrist evaluation. Standardized wrist radiographs were used to assess wrist morphology and the Knirk and Jupiter’s degree of osteoarthritis. Multivariate logistic regression was used to analyze postoperative morphological changes in the wrist and carpal alignment regarding their correlation with progression of wrist osteoarthritis. Results: Progression of postoperative wrist osteoarthritis was recognized in 37 of the 56 cases (66.1%). Compared with the clinical outcomes at the time of the fracture union completion, almost clinical outcomes improved up to 5 years follow-up time as well as at 1 year after surgery. The range of wrist flexion at 5 years follow-up was significantly less in the progressive osteoarthritis group than in those with non-progressive osteoarthritis. The persistent step-off immediately after surgery significantly affected the postoperative progression of wrist osteoarthritis. Changes in the radial inclination, volar tilt, and radioscaphoid angle correlated with progression of wrist osteoarthritis. The highest correlation was with the change of radioscaphoid angle. Conclusions: Good clinical results were maintained at 5 years after surgery, but progression of postoperative wrist osteoarthritis interfered with improvement of wrist flexion. Change in the radioscaphoid angle was the factor that was most highly correlated with progression of postoperative wrist osteoarthritis.

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Immediate mobilization of distal radius fractures stabilized by volar locking plate results in a better short-term outcome than a five week immobilization: A prospective randomized trial

Clinical Rehabilitation ◽

10.1177/02692155211036674 ◽

2021 ◽

pp. 026921552110366

Author(s):

Stefan Quadlbauer ◽

Christoph Pezzei ◽

Josef Jurkowitsch ◽

Brigitta Kolmayr ◽

Daniel Simon ◽

...

Keyword(s):

Confidence Interval ◽

Range Of Motion ◽

Distal Radius ◽

Locking Plate ◽

Mean Difference ◽

Distal Radius Fractures ◽

Radius Fractures ◽

Cast Immobilization ◽

One Year ◽

Immediate Mobilization

Objective: To evaluate the impact of immediate (first day after surgery) mobilization compared to standard five weeks cast immobilization on the functional outcome after volar locking plate fixation of distal radius fractures. Design: Prospective randomized parallel group comparative trial. Setting: Trauma Hospital, Austria. Participants: Patients with isolated unstable distal radius fractures, stabilized with volar angular stable locking plate. Interventions: The immediate mobilization group received a removable forearm splint for one week and active supervised group physiotherapy and home exercises for the shoulder, elbow, wrist, and fingers from the first postoperative day. The cast immobilization group received a non-removable cast for five weeks. In the first five weeks supervised group physiotherapy and home exercises were performed for shoulder, elbow, and fingers. Thereafter additional supervised and home exercises for the wrist were started. Main measures: At regular intervals of six and nine weeks, three and six months, and one year post surgery range of motion, grip strength, and x-rays were evaluated. Additionally, the shortened disabilities of the arm, shoulder and hand ( QuickDASH) score, Patient-rated Wrist Evaluation, Mayo Wrist score, and pain according to the Visual Analog Scale score were analyzed. Results: One hundred and sixteen patients were prospectively randomized into two study groups. At the one-year follow-up, patients in the immediate mobilization group showed a significantly higher range of motion in extension/flexion (mean difference 10.2°, 99% confidence interval 0.6–19.8), grip strength (mean difference 5.1 kg, 99% confidence interval −0.5 to 10.7), and Mayo Wrist score (mean difference 7.9 points, 99% confidence interval 2.3–13.5) than the cast immobilization group. Range of motion in supination/pronation (mean difference 13.4°, 99% confidence interval 1.5–25.3) and in radial/ulnar deviation (mean difference 6.3°, 99% confidence interval 0.9–11.7) differed significantly up to nine weeks favoring the immediate mobilization group. The Patient-rated Wrist Evaluation revealed significantly better scores after three months (mean difference 9.3 points, 99% confidence interval 0.5–18.1) and QuickDASH after six months (mean difference 7.3 points, 99% confidence interval 0.3–14.3) in the immediate mobilization group. All other subsequent follow-up examinations indicated no significant differences in respect of pain, range of motion, and patient-reported outcome measurements between the study groups. There were no significant differences in respect of radiological loss of reduction and complications between the groups. Conclusions: Immediate mobilization in combination with supervised physiotherapy of the wrist after volar locking plate fixation of unstable distal radius fractures results in a significantly improved range of motion and grip strength after one year compared to cast immobilization. No increased risk for loss of reduction and other complications was observed.

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Dual Plating Technique for Volar Rim Fracture of the Distal Radius Using DePuy-Synthes 2.0 m and 2.4 mm Locking Plates

The Journal of Hand Surgery (Asian-Pacific Volume) ◽

10.1142/s0218810417500447 ◽

2017 ◽

Vol 22 (04) ◽

pp. 423-428 ◽

Cited By ~ 1

Author(s):

Yoshihiro Abe ◽

Masahiro Suzuki ◽

Hiromasa Wakita

Keyword(s):

Range Of Motion ◽

Grip Strength ◽

Distal Radius ◽

Distal Radius Fractures ◽

Ulnar Variance ◽

Locking Plates ◽

Radius Fractures ◽

Radial Inclination ◽

The Mean

Background: To assess the surgical results of distal radius fractures with the involvement of a volar rim fragment using the DePuy-Synthes 2.0 mm and 2.4 mm locking plates.Methods: Subjects were six women and one man of average age 57 years (range, 31–83 y) and a mean follow-up period of 9 months (range, 5–19 mo) with AO B3 (volar shearing) distal radius fractures. Time of the procedure, physical examination of wrist range of motion, grip strength compared with the contralateral healthy wrist, and radiographic evaluation (volar tilt, radial inclination, and ulnar variance) were evaluated. The Visual Analog Scale (VAS: 0 points represents no pain, 100 points represents the worst pain possible) and the Quick Disability of the Arm, Shoulder, and Hand questionnaire (QuickDASH, 0 = no disability, 100 = extreme disability) were completed by patients at the final follow-up.Results: The average time of the procedure was 74 min. There were no perioperative complications. Average radiographic measures were: volar tilt, 8°; radial inclination, 23°, and ulnar variance, 0 mm. Wrist range of motion averaged 63° in wrist extension (range, 55–80°) and 55° in wrist flexion (range, 45–65°). Grip strength averaged 81% of the contralateral side at final evaluation (range, 67–100%). The mean QuickDASH score was 3.0 points (range, 0–9.1 points) and the mean VAS for pain was 9.3 at final follow-up.Conclusions: Open reduction internal fixation with the DePuy-Synthes 2.0 mm and 2.4 mm locking plates is an effective means of fixing a distal radius fracture that includes a volar rim fragment without interfering with flexor tendon gliding.

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Volar Locking Plating for the Intra- and Extra-articular Distal Radius Fractures With Dorsal Metaphyseal Comminution

10.21203/rs.3.rs-564409/v1 ◽

2021 ◽

Author(s):

Xue-yang Gui ◽

Zhao-hui Cheng ◽

Hongfei Shi ◽

Yi-xin Chen ◽

Jin Xiong ◽

...

Keyword(s):

Distal Radius ◽

Locking Plate ◽

Plate Fixation ◽

Distal Radius Fractures ◽

Volar Locking Plate ◽

Radius Fractures ◽

Locking Plate Fixation ◽

Articular Fractures ◽

Metaphyseal Comminution

Abstract Background: Volar locking plating remains a popular method for the surgical management of distal radius fractures. Dorsal metaphyseal comminution (DMC) is a common fracture pattern which weakens the stability during fracture fixation. In this study, we aimed to compare the radiographic and functional outcome of the intra- and extra-articular distal radius fractures with DMC following volar locking plate fixation.Materials and methods: Patients suffered from a distal radius fracture with DMC were reviewed in the clinical database of the authors’ institution between Jan 2016 and Jan 2020. The included patients were classified into the extra-articular (A3) group or the intra-articular (C2 and C3) group according to the AO/OTA system. The radiological parameters, wrist range of motion, and functional outcomes were evaluated following open reduction and volar locking plate fixation.Results: A total of 130 patients were included in this study with a mean follow-up length of 17.2 months. Compared with the A3 fracture group, no significant fracture re-displacement or reduced wrist ROMs was observed in the C2 fractures after 12-month’s follow-up. However, significantly decreased volar tilt (P = 0.003) as well as the extension/flexion ROMs were observed in the C3 fractures comparing to the A3 fractures. Most of the patients achieved an excellent (n = 75) or good (n = 51) Gartland and Werley wrist score. Four patients with C3 fractures resulted in a fair functional outcome due to a significant loss of volar tilt during follow-up.Conclusions: The volar locking plate fixation provided sufficient stability for distal radius fractures with DMC, and resulted in similar radiological and functional outcomes in the intra-articular distal radius fractures with a simple articular component (C2 fractures) as those in the extra-articular fractures. Considering the intra-articular fractures with multifragmentary articular component (C3 fracture), despite of the subsequent loss of volar tilt, the majority of the patients achieved good to excellent wrist function following volar locking plating.Trial registration: Not applicable because the design of the study is retrospective.

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Comparison of functional outcome of extra-articular distal radius fractures treated by volar locking plate versus percutaneous pinning in adults-a retrospective study

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20211618 ◽

2021 ◽

Vol 7 (3) ◽

pp. 611

Author(s):

Shushrut B. Bhavi ◽

Amith Shanmukgouda Kallanagoudar ◽

Deepak Kaladagi ◽

N. B. Sanakal

Keyword(s):

Retrospective Study ◽

Distal Radius ◽

Locking Plate ◽

Distal Radius Fractures ◽

Dash Score ◽

Volar Locking Plate ◽

Percutaneous Pinning ◽

Radius Fractures ◽

Plate Group

Background: Distal radius fractures are one of the most common fractures in an adult population and accounts for 17.5% of all the fractures. The management of distal radius fractures remains debatable despite the availability of different methods of treatment. The aim of this study is to assess the functional outcomes of extra-articular distal radius fractures treated with percutaneous pinning or internal fixation with volar locking plate in adults.Methods: A retrospective study of 40 patients diagnosed with distal radius fracture with AO classification were treated either with percutaneous pinning (n=20) or open reduction and internal fixation with volar locking plate (n=20) were included in study. DASH score and radiographs at 6th month was assessed for functional outcome and radiological union.Results: Mean age in plate group was 40 and 45 years in K wire group. The mean passive wrist ROM at the final follow-up evaluation in plate group was 63.8o extension and 70.5o flexion, 81.7o supination and 79o pronation, compared with 56.75o extension and 65.25o flexion, 74.7o supination and 85.5o pronation in patients treated with K wire group. Patients with plate group and K wire group had DASH score of 19.85 and 18.49 respectively (p=0.07) at 6 months follow-up.Conclusions: The use of ORIF with plate resulted in stable fixation of the unstable extraarticular fractures, allowing early post-surgical wrist motion and has good radiological outcome whereas K wire also has advantages of being minimal invasive, reduced hospital stay and minimal cost.

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Functional and radiological outcome of distal radius fractures stabilized by volar-locking plate with a minimum follow-up of 1 year

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-020-03411-9 ◽

2020 ◽

Vol 140 (6) ◽

pp. 843-852 ◽

Cited By ~ 3

Author(s):

Stefan Quadlbauer ◽

Ch. Pezzei ◽

J. Jurkowitsch ◽

R. Rosenauer ◽

A. Pichler ◽

...

Keyword(s):

Distal Radius ◽

Locking Plate ◽

Distal Radius Fractures ◽

Volar Locking Plate ◽

Radiological Outcome ◽

Radius Fractures

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Radiological outcomes of AO type B and C distal radius fractures managed with 2.7 mm volar locking plate fixation in geriatric population: a retrospective analysis

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20212419 ◽

2021 ◽

Vol 7 (4) ◽

pp. 768

Author(s):

Prakashappa Thamalehally Hanumanthappa ◽

Bharath Raja B. S. ◽

Muthu Kishore Marichamy

Keyword(s):

Distal Radius ◽

Locking Plate ◽

Plate Fixation ◽

Distal Radius Fractures ◽

Volar Locking Plate ◽

Type B ◽

Radius Fractures ◽

Locking Plate Fixation ◽

Geriatric Population

Background: Distal end radius fractures are one of the most common fractures. Compared to younger patients, elderly with distal radius fractures with osteoporosis and higher comminution compromise the treatment outcomes. Anatomic reduction with stable fixation is usually the choice of treatment for displaced intra-articular fractures. While osteoporosis and poor bone quality hamper fracture stabilization, locking compression plates (LCPs) provide enhanced stability and axial loading force as compared to conventional plates. The current study retrospectively analysed the postoperative radiological outcomes in a 2.7 mm volar LCP system used for internal stabilisation of intra articular distal radius fractures.Methods: A retrospective study was conducted in the Sanjay Gandhi institute of trauma and orthopaedics, Bangalore from June 2018 to July 2020. All Arbeitsgemeinschaft für Osteosynthesefragen (AO) type B and C distal radius fractures of patients aged 60 and above who underwent 2.7 mm volar locking plate fixation during that time period were analysed with X-rays at immediate post-operative, six weeks and three months. The radiological outcome was scored based on Sarmiento’s modification of Lindstorm criteria.Results: The mean immediate post-operative radial shortening, decrease in radial deviation and loss of palmar tilt were 3.80±1.03, 4.38±1.05 and 3.97±1.02, respectively. The corresponding values at last follow up were 4.31±1.12, 6.19±1.02 and 4.76±0.99, respectively. No statistically significant difference (p=0.949; p=1.0; p=0.996) in radial shortening, loss of radial deviation and decrease in palmar angulation was seen till the final follow up. Sarmiento’s modification of Lindstorm criteria showed a good radiological outcome in 80% and excellent in 20%.Conclusions: Use of 2.7 mm volar LCP showed good to excellent post-operative radiological outcomes in geriatric population. The fracture reduction achieved in the immediate post-operative period is maintained throughout the follow up duration without any significant change.

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