Functional outcome of volar locking plate for unstable distal radius fractures

Introduction: Distal radius fractures are the most common fractures in elderly. Unstable fractures are best managed surgically and the results of volar locking plates have been promising. The purpose of this study is to determine the functional outcome of volar locking plates in the treatment of unstable distal radius fractures. Methods: Forty-five patients with 46 unstable distal radius fractures were enrolled for this study, conducted at Chitwan Medical College from September 2016 to April 2017. All patients were treated with a 3.5mm titanium volar locking plate and followed-up for a minimum of one year. The assessment was done using radiological evaluation and Cooney modification of the Green and O’Brien scoring system. Results: Twenty-three men and 22 women with age ranging from 15-75 years (mean 43.22 years) were followed-up for an average of 16.53 months. There were 17 type A fractures (5 A2, 12 A3), 11 type B fractures (3 B1, 1 B2, 7 B3), and 18 type C fractures (4 C1, 12 C2, 2 C3) (AO classification). The mean time for union was 7.96 weeks. Functional outcome using modified Green and O’Brien Score was 20 excellent, 15 good, 7 fair and 4 poor results (76.1% good to excellent results). The overall complication rate was 15.22%. Conclusion: Volar locking plates provide adequate fixation for unstable distal radius fractures with minimal loss of reduction and satisfactory functional outcome.

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Functional outcome in patients with unstable distal radius fractures, volar locking plate versus external fixation: a meta-analysis

Strategies in Trauma and Limb Reconstruction ◽

10.1007/s11751-013-0169-4 ◽

2013 ◽

Vol 8 (2) ◽

pp. 67-75 ◽

Cited By ~ 31

Author(s):

J. C. Goslings ◽

Monique M. J. Walenkamp ◽

Abdelali Bentohami ◽

M. Suzan H. Beerekamp ◽

Rolf W. Peters ◽

...

Keyword(s):

Functional Outcome ◽

External Fixation ◽

Distal Radius ◽

Locking Plate ◽

Meta Analysis ◽

Distal Radius Fractures ◽

Plate Versus ◽

Volar Locking Plate ◽

Radius Fractures

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Osteosynthesis of Unstable Fractures of Distal Radius with Volar Locking Plate

Nepal Orthopaedic Association Journal ◽

10.3126/noaj.v2i1.8137 ◽

2013 ◽

Vol 2 (1) ◽

pp. 27-34

Author(s):

RL Pradhan ◽

S Sharma ◽

BK Pandey ◽

RR Manandhar ◽

S Lakhey ◽

...

Keyword(s):

Functional Outcome ◽

Distal Radius ◽

Locking Plate ◽

Distal Radius Fractures ◽

Volar Locking Plate ◽

Radius Fractures ◽

Volar Aspect ◽

Clinical And Radiological Outcome ◽

Clinical Scoring ◽

Unstable Fractures

Background: Various surgical treatment methods are available for unstable distal radius fractures. Clinical and radiological outcome with volar locking plate has been very satisfactory. The purpose of this prospective study is to evaluate the results of the treatment of unstable fractures with the volar locking plate with regard to loss of reduction, functional outcome and complications. Methods: Unstable distal radius fractures were enrolled for the study from May 2008 until July 2010. All patients were treated with 3.5 mm distal radius volar locking plate and assessed by clinical and radiological examination. The clinical scoring chart modified by Cooney was used to evaluate the functional outcome. Results: Eighteen male and 12 female patients with the average age of 42.53 (range 30- 64years) were followed up for a period of 9 to 34 months (average.23 months). There were fourteen A3 fractures, nine C1 fractures, six C2 fractures, and one C3 fracture, whereas one had a Gustilo grade I open wound on the volar aspect. Seven of the fractures had associate fracture of the ulnar styloid. The functional outcome was excellent in 23 (76%), good in 6 (20%), fair in 1 (4%) and none had poor outcome. There were very few complications in our series. Conclusion: Unstable fractures of distal radius treated by open reduction with volar locking plate provides adequate fixation with no collapse in reduction and also have satisfactory functional outcome with minimal complications. DOI: http://dx.doi.org/10.3126/noaj.v2i1.8137 Nepal Orthopaedic Association Journal Vol.2(1) 2011: 27-34

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Functional Outcome and Complications at 2.5 Years Following Volar Locking Plate Fixation of Distal Radius Fractures

Journal of Hand and Microsurgery ◽

10.1007/s12593-014-0155-1 ◽

2016 ◽

Vol 07 (01) ◽

pp. 18-24 ◽

Cited By ~ 10

Author(s):

Robert MacFarlane ◽

David Miller ◽

Lynn Wilson ◽

Carl Meyer ◽

Cronan Kerin ◽

...

Keyword(s):

Functional Outcome ◽

Distal Radius ◽

Locking Plate ◽

Plate Fixation ◽

Distal Radius Fractures ◽

Volar Locking Plate ◽

Radius Fractures ◽

Locking Plate Fixation

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A prospective study to assess the functional outcome of AO Type 23.B3 distal radius fractures treated with volar locking plate osteosynthesis

International Journal of Orthopaedics Sciences ◽

10.22271/ortho.2020.v6.i4l.2427 ◽

2020 ◽

Vol 6 (4) ◽

pp. 831-834

Author(s):

Dr. Pradeep E ◽

Dr. Sathik Babu MB ◽

Dr. Prajin Raj M ◽

Dr. Dinesh Kumar S

Keyword(s):

Prospective Study ◽

Functional Outcome ◽

Distal Radius ◽

Locking Plate ◽

Plate Osteosynthesis ◽

Distal Radius Fractures ◽

Volar Locking Plate ◽

Radius Fractures ◽

Locking Plate Osteosynthesis ◽

A Prospective Study

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Saving Tendons on Distal Radius Fractures: A Simple Surgical Pearl to Prevent FPL Tendon Conflict with Volar Locking Plates

Journal of Wrist Surgery ◽

10.1055/s-0036-1597576 ◽

2016 ◽

Vol 06 (03) ◽

pp. 248-250 ◽

Cited By ~ 1

Author(s):

Gustavo Ruggiero

Keyword(s):

Soft Tissue ◽

Surgical Technique ◽

Distal Radius ◽

Locking Plate ◽

Distal Radius Fractures ◽

Locking Plates ◽

Volar Locking Plate ◽

Flexor Pollicis Longus ◽

Radius Fractures ◽

Tissue Protection

AbstractInjury to the flexor pollicis longus (FPL) tendon is one of the most frequent complications when fixing distal radius fractures with the volar locking plates. The author proposed a simple surgical technique providing a reliable soft tissue protection to prevent friction on the FPL with the volar locking plate, using a flap of the FCR sheath sutured to attachments of the volar capsule on the lunate buttress facet of the distal radius.

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Dorsally Comminuted Fractures of the Distal End of the Radius: Osteosynthesis with Volar Fixed Angle Locking Plates

ISRN Orthopedics ◽

10.1155/2013/131757 ◽

2013 ◽

Vol 2013 ◽

pp. 1-6 ◽

Cited By ~ 3

Author(s):

Paritosh Gogna ◽

Harpal Singh Selhi ◽

Rohit Singla ◽

Ashish Devgan ◽

Narender Kumar Magu ◽

...

Keyword(s):

Distal Radius ◽

Locking Plate ◽

Plate Fixation ◽

Distal Radius Fractures ◽

Point System ◽

Functional Evaluation ◽

Volar Locking Plate ◽

Radius Fractures ◽

Loss Of Reduction ◽

Comminuted Fractures

Background. Dorsally comminuted distal radius fractures are unstable fractures and represent a treatment challenge. The objective of this study was to evaluate the functional and radiological outcome of dorsally comminuted fractures of the distal radius fixed with a volar locking plate. Patients and Methods. Thirty-three consecutive patients with dorsally comminuted fractures of the distal end of the radius were treated by open reduction and internal fixation with AO 2.4 mm (n=19)/3.5 mm (n=14) volar locking distal radius plate (Synthes, Switzerland, marketed by Synthes India Pvt. Ltd.). There were 7 type A3, 8 type C2, and 18 type C3 fractures. The patients were followed up at 6 weeks, 3 months, 6 months, and 1 year postoperatively. Subjective assessment was done as per Disabilities Arm, Shoulder, and Hand (DASH) questionnaire. Functional evaluation was done by measuring grip strength and range of motion around the wrist; the radiological determinants were radial angle, radial length, volar angle, and ulnar variance. The final assessment was done as per Demerit point system of Saito. Results. There were 23 males and 10 females with an average age of 44.12 ± 18.63 years (18–61 years). Clinicoradiological consolidation of the fracture was observed in all cases at a mean of 9.6 weeks (range 7–12 weeks). The average final extension was 58.15° ± 7.83°, flexion was 54.62° ± 11.23°, supination was 84.23° ± 6.02°, and pronation was 80.92° ± 5.54°. Demerit point system of Saito yielded excellent results in 79% (n=26), good in 18% (n=6), and fair in 3% (n=1) patients. Three patients had loss of reduction but none of the patients had tendon irritation or ruptures, implant failure, or nonunion at the end of an one-year followup. Conclusion. Volar locking plate fixation for dorsally comminuted distal radius fractures results in good to excellent functional outcomes despite a high incidence of loss of reduction and fracture collapse.

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

International Journal of Innovative Research in Medical Science ◽

10.23958/ijirms/vol06-i05/1131 ◽

2021 ◽

Vol 6 (05) ◽

pp. 358-365

Author(s):

Kastanis G ◽

Pantouvaki A ◽

Kapsetakis P ◽

Spyrantis M ◽

Magarakis G ◽

...

Keyword(s):

Range Of Motion ◽

Grip Strength ◽

Distal Radius ◽

Locking Plate ◽

Distal Radius Fractures ◽

Volar Locking Plate ◽

Radius Fractures ◽

One Year ◽

Quick Dash

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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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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Clino-radiological and functional outcome of intra-articular distal radius fractures treated with volar locking plate system

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20192677 ◽

2019 ◽

Vol 5 (4) ◽

pp. 645

Author(s):

Mohan Rao ◽

Siddharth Gupta ◽

P. V. Jayasankar ◽

Vinit Yadav ◽

Sudhakar Williams

Keyword(s):

Distal Radius ◽

Locking Plate ◽

Distal Radius Fractures ◽

Dash Score ◽

Locking Plates ◽

Volar Locking Plate ◽

Radius Fractures ◽

Chi Square ◽

Male Preponderance ◽

Locking Plate System

Background: No uniform consensus exists to decide type of fixation for unstable distal radius fractures. The objective of the study is to evaluate the patients on regular follow up for radiological & functional status. We evaluated the effectiveness and outcomes of unstable distal radius fractures treated with locking plates.Methods: The study design was prospective observational study. 36 patients with distal radius fractures deemed unsuitable for conservative management underwent ORIF with a volar locking plate. The evaluation methods were clinical examination, DASH score and PRWE score. Patients were followed up from minimum of 2 weeks to 6 months. This data was analysed in MS excel and SPSS software version 19.0 for testing the association between different variables by using the chi-square tests.Results: The mean age of patients was 45 years with male preponderance. As per DASH score 17 patients had zero score implying no disability. In the remaining 19 patients score ranged from 4 to 24 with a mean of 11 indicating good outcome. PRWE score was best in 17 patients and worst in zero patients.Conclusions: The fixation of unstable distal radius fractures with volarly applied locking plates without bone grafting and prolonged immobilisation is an effective method & hence has gained worldwide acceptance and is highly recommended.

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