Volar Plate Fixation of Intra-Articular Distal Radius Fractures: A Retrospective Study

Abstract

Background Intra-articular fractures of the distal radius represent a therapeutic challenge as compared with the unstable extra-articular fractures. With the recent development of specifically designed internal fixation materials for the distal radius, treatment of these fractures by fragment-specific implants using two or more incisions has been advocated.

Purpose The purpose of this study was to investigate the efficacy of a fixed-angle locking plate applied through a single volar approach in maintaining the radiographic alignment of unstable intra-articular fractures as well as to report the clinical outcomes. We only excluded those with massive comminution, as is discussed in greater detail in the text.

Patients and Methods This is a multicentered, retrospective study involving three hospitals situated in Spain, Switzerland, and the United States. In the period between January 2000 and March 2006, 97 patients with 101 intra-articular distal radius fractures, including 13 volarly displaced and 88 dorsally angulated fractures were analyzed. Over 80% were C2/C3 fractures, based on the AO classification. 16 open fractures were noted.

Results With an average follow-up of 28 months (range 24–70 months), the range of movement of the wrist was very satisfactory, and the mean grip strength was 81% of the opposite wrist. The Disabilities of the Arm, Shoulder, and Hand (DASH) score was 8. The complications rate was < 5%, including loss of reduction in two patients. All fractures healed by 3 months postinjury.

Conclusions Irrespective of the direction and amount of initial displacement, a great majority of intra-articular fractures of the distal radius can be managed with a fixed-angle volar plate through a single volar approach.

Level IV retrospective case series

Keywords

distal radius fractures - volar plate - internal fixation - intra-articular fractures

Notes

This study does not receive any financial support from any company or government body.

None of the cases, illustrations, images, and figures given contains any identifiable patient information.

• References

• 1 Cooney III WP, Linscheid RL, Dobyns JH. External pin fixation for unstable Colles' fractures. J Bone Joint Surg Am 1979; 61 (6A): 840-845
• 2 Arora R, Lutz M, Deml C, Krappinger D, Haug L, Gabl M. A prospective randomized trial comparing nonoperative treatment with volar locking plate fixation for displaced and unstable distal radial fractures in patients sixty-five years of age and older. J Bone Joint Surg Am 2011; 93 (23) 2146-2153
• 3 Trumble TE, Schmitt SR, Vedder NB. Factors affecting functional outcome of displaced intra-articular distal radius fractures. J Hand Surg Am 1994; 19 (2) 325-340
• 4 Wolfe SW, Pike L, Slade III JF, Katz LD. Augmentation of distal radius fracture fixation with coralline hydroxyapatite bone graft substitute. J Hand Surg Am 1999; 24 (4) 816-827
• 5 Medoff RJ. Fragment-specific fixation of distal radius fractures. Atlas of the Hand Clinics 2006; 11 (2) 163-174
• 6 Orbay JL, Fernandez DL. Volar fixation for dorsally displaced fractures of the distal radius: a preliminary report. J Hand Surg Am 2002; 27 (2) 205-215
• 7 Musgrave DS, Idler RS. Volar fixation of dorsally displaced distal radius fractures using the 2.4-mm locking compression plates. J Hand Surg Am 2005; 30 (4) 743-749
• 8 Müller MNazarian S, Koch P, Schatzker J. The Comprehensive Classification of Fractures of Long Bones. Berlin, Germany: Springer-Verlag; 1990
• 9 Castaing J. Recent fractures of the lower extremity of the radius in adults [in French]. Rev Chir Orthop Repar Appar Mot 1964; 50: 581-696
• 10 Soong M, Got C, Katarincic J, Akelman E. Fluoroscopic evaluation of intra-articular screw placement during locked volar plating of the distal radius: a cadaveric study. J Hand Surg Am 2008; 33 (10) 1720-1723
• 11 Joseph SJ, Harvey JN. The dorsal horizon view: detecting screw protrusion at the distal radius. J Hand Surg Am 2011; 36 (10) 1691-1693
• 12 Atzei A. New trends in arthroscopic management of type 1-B TFCC injuries with DRUJ instability. J Hand Surg Eur Vol 2009; 34 (5) 582-591
• 13 Fernandez DL. Radial osteotomy and Bowers arthroplasty for malunited fractures of the distal end of the radius. J Bone Joint Surg Am 1988; 70 (10) 1538-1551
• 14 Jakob M, Rikli DA, Regazzoni P. Fractures of the distal radius treated by internal fixation and early function. A prospective study of 73 consecutive patients. J Bone Joint Surg Br 2000; 82 (3) 340-344
• 15 Lutz M, Arora R, Krappinger D, Wambacher M, Rieger M, Pechlaner S. Arthritis predicting factors in distal intraarticular radius fractures. Arch Orthop Trauma Surg 2011; 131 (8) 1121-1126
• 16 Edwards Jr GS. Intra-articular fractures of the distal part of the radius treated with the small AO external fixator. J Bone Joint Surg Am 1991; 73 (8) 1241-1250
• 17 Bini A, Surace MF, Pilato G. Complex articular fractures of the distal radius: the role of closed reduction and external fixation. J Hand Surg Eur Vol 2008; 33 (3) 305-310
• 18 Glickel SZ, Catalano LW, Raia FJ, Barron OA, Grabow R, Chia B. Long-term outcomes of closed reduction and percutaneous pinning for the treatment of distal radius fractures. J Hand Surg Am 2008; 33 (10) 1700-1705
• 19 Ellis J. Smith's and Barton's fractures. A method of treatment. J Bone Joint Surg Br 1965; 47 (4) 724-727
• 20 Jupiter JB, Fernandez DL, Toh CL, Fellman T, Ring D. Operative treatment of volar intra-articular fractures of the distal end of the radius. J Bone Joint Surg Am 1996; 78 (12) 1817-1828
• 21 Khamaisy S, Weil YA, Safran O, Liebergall M, Mosheiff R, Khoury A. Outcome of dorsally comminuted versus intact distal radial fracture fixed with volar locking plates. Injury 2011; 42 (4) 393-396
• 22 Chung KC, Petruska EA. Treatment of unstable distal radial fractures with the volar locking plating system. Surgical technique. J Bone Joint Surg Am 2007; 89 (Suppl 2 Pt.2): 256-266
• 23 Rozental TD, Blazar PE. Functional outcome and complications after volar plating for dorsally displaced, unstable fractures of the distal radius. J Hand Surg Am 2006; 31 (3) 359-365
• 24 Egol K, Walsh M, Tejwani N, McLaurin T, Wynn C, Paksima N. Bridging external fixation and supplementary Kirschner-wire fixation versus volar locked plating for unstable fractures of the distal radius: a randomised, prospective trial. J Bone Joint Surg Br 2008; 90 (9) 1214-1221
• 25 Wright TW, Horodyski M, Smith DW. Functional outcome of unstable distal radius fractures: ORIF with a volar fixed-angle tine plate versus external fixation. J Hand Surg Am 2005; 30 (2) 289-299
• 26 Harness NG, Jupiter JB, Orbay JL, Raskin KB, Fernandez DL. Loss of fixation of the volar lunate facet fragment in fractures of the distal part of the radius. J Bone Joint Surg Am 2004; 86-A (9) 1900-1908
• 27 Gehrmann SV, Windolf J, Kaufmann RA. Distal radius fracture management in elderly patients: a literature review. J Hand Surg Am 2008; 33 (3) 421-429
• 28 Orbay JL, Fernandez DL. Volar fixed-angle plate fixation for unstable distal radius fractures in the elderly patient. J Hand Surg Am 2004; 29 (1) 96-102
• 29 Chiang PP, Roach S, Baratz ME. Failure of a retinacular flap to prevent dorsal wrist pain after titanium Pi plate fixation of distal radius fractures. J Hand Surg Am 2002; 27 (4) 724-728
• 30 Tyllianakis ME, Panagopoulos AM, Saridis A. Long-term results of dorsally displaced distal radius fractures treated with the pi-plate: Is hardware removal necessary?. Orthopedics 2011; 34 (7) e282-e286
• 31 Berglund LM, Messer TM. Complications of volar plate fixation for managing distal radius fractures. J Am Acad Orthop Surg 2009; 17 (6) 369-377
• 32 Benson EC, DeCarvalho A, Mikola EA, Veitch JM, Moneim MS. Two potential causes of EPL rupture after distal radius volar plate fixation. Clin Orthop Relat Res 2006; 451: 218-222
• 33 Yu YR, Makhni MC, Tabrizi S, Rozental TD, Mundanthanam G, Day CS. Complications of low-profile dorsal versus volar locking plates in the distal radius: a comparative study. J Hand Surg Am 2011; 36 (7) 1135-1141
• 34 Soong M, van Leerdam R, Guitton TG, Got C, Katarincic J, Ring D. Fracture of the distal radius: risk factors for complications after locked volar plate fixation. J Hand Surg Am 2011; 36 (1) 3-9
• 35 Koo SC, Ho ST. Delayed rupture of flexor pollicis longus tendon after volar plating of the distal radius. Hand Surg 2006; 11 (1-2) 67-70
• 36 Casaletto JA, Machin D, Leung R, Brown DJ. Flexor pollicis longus tendon ruptures after palmar plate fixation of fractures of the distal radius. J Hand Surg Eur Vol 2009; 34 (4) 471-474
• 37 Cross AW, Schmidt CC. Flexor tendon injuries following locked volar plating of distal radius fractures. J Hand Surg Am 2008; 33 (2) 164-167
• 38 Nunley JA, Rowan PR. Delayed rupture of the flexor pollicis longus tendon after inappropriate placement of the Pi plate on the volar surface of the distal radius. J Hand Surg Am 1999; 24 (6) 1279-1280
• 39 Trumble TE, Culp RW, Hanel DP, Geissler WB, Berger RA. Intra-articular fracture of the distal aspect of the radius–An Instructioanl Course lecture: The American Academy of Orthopaedic Surgeons. J Bone Joint Surg Am 1998; 80 (4) 582-600
• 40 Bradway JK, Amadio PC, Cooney WP. Open reduction and internal fixation of displaced, comminuted intra-articular fractures of the distal end of the radius. J Bone Joint Surg Am 1989; 71 (6) 839-847
• 41 Lindau T, Hagberg L, Adlercreutz C, Jonsson K, Aspenberg P. Distal radioulnar instability is an independent worsening factor in distal radial fractures. Clin Orthop Relat Res 2000; (376) 229-235
• 42 Zenke Y, Sakai A, Oshige T, Moritani S, Nakamura T. The effect of an associated ulnar styloid fracture on the outcome after fixation of a fracture of the distal radius. J Bone Joint Surg Br 2009; 91 (1) 102-107
• 43 Buijze GA, Ring D. Clinical impact of united versus nonunited fractures of the proximal half of the ulnar styloid following volar plate fixation of the distal radius. J Hand Surg Am 2010; 35 (2) 223-227
• 44 Kim JK, Koh YD, Do NH. Should an ulnar styloid fracture be fixed following volar plate fixation of a distal radial fracture?. J Bone Joint Surg Am 2010; 92 (1) 1-6