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J Wrist Surg 2018; 07(03): 237-242
DOI: 10.1055/s-0037-1620271
Scientific Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Volar Locking Plate Fixation of Distal Radius Fractures: Splint versus Immediate Mobilization

André Duprat
1   Department of Hand Surgery, SOS Main, CCOM, University Hospital of Strasbourg, Translational Medicine Federation Strasbourg, University of Strasbourg, Illkirch, France
,
Juan José Hidalgo Diaz
1   Department of Hand Surgery, SOS Main, CCOM, University Hospital of Strasbourg, Translational Medicine Federation Strasbourg, University of Strasbourg, Illkirch, France
,
Paul Vernet
1   Department of Hand Surgery, SOS Main, CCOM, University Hospital of Strasbourg, Translational Medicine Federation Strasbourg, University of Strasbourg, Illkirch, France
,
Stéphanie Gouzou
1   Department of Hand Surgery, SOS Main, CCOM, University Hospital of Strasbourg, Translational Medicine Federation Strasbourg, University of Strasbourg, Illkirch, France
,
Sybille Facca
1   Department of Hand Surgery, SOS Main, CCOM, University Hospital of Strasbourg, Translational Medicine Federation Strasbourg, University of Strasbourg, Illkirch, France
,
Yuka Igeta
1   Department of Hand Surgery, SOS Main, CCOM, University Hospital of Strasbourg, Translational Medicine Federation Strasbourg, University of Strasbourg, Illkirch, France
2   Department of Orthopedic Surgery, Juntendo University, Tokyo, Japan
,
Philippe Liverneaux
1   Department of Hand Surgery, SOS Main, CCOM, University Hospital of Strasbourg, Translational Medicine Federation Strasbourg, University of Strasbourg, Illkirch, France
› Author Affiliations
Further Information

Publication History

25 October 2017

12 December 2017

Publication Date:
16 January 2018 (online)

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Abstract

Background The goal of this study was to demonstrate that the use of a splint after performing an osteosynthesis of the distal radius with a volar locking plate is unnecessary. The main hypothesis was that postoperative flexion of the wrist was greater without a splint. Secondary hypothesis was that patients who were allowed immediate mobilization got better results in terms of pain, Quick Disabilities of the Arm, Shoulder and Hand (DASH), Patient-Rated Wrist Evaluation (PRWE), strength, extension, pronation, and supination.

Case Description Our series included 72 patients, aged 59 years in average of which 59 were female patients. All patients had been operated for a volar locking plate fixation of a distal radius fracture. The first 36 patients (group I) were immobilized by a splint at 30° of extension of the wrist for 2 weeks. The following 36 patients (group II) were not immobilized.

Results At 3 months, all the average variables were better in the group without splint (group I: flexion 74.83%, extension 83.13%, pronation 92.07%, supination 88.11%, pain 1.72/10, Quick DASH 21.78/100, PRWE 22.97/100, strength 62.96%; group II: flexion 85.50%, extension 83.4%, pronation 92.96%, supination 92.96%, pain 1.28/10, Quick DASH 19.57/100, PRWE 20.56/100, strength 66.34%). No complication was reported.

Conclusion Overall, our results demonstrate that wearing a splint after volar locking plate fixation of a distal radius fracture is unnecessary.

Keywords

volar plate - distal radius fractures - splint - mobilization
 

  • References

  • 1 Schneppendahl J, Windolf J, Kaufmann RA. Distal radius fractures: current concepts. J Hand Surg Am 2012; 37 (08) 1718-1725
    CrossrefPubMedGoogle Scholar
  • 2 Wilcke MK, Hammarberg H, Adolphson PY. Epidemiology and changed surgical treatment methods for fractures of the distal radius: a registry analysis of 42,583 patients in Stockholm County, Sweden, 2004–2010. Acta Orthop 2013; 84 (03) 292-296
    CrossrefPubMedGoogle Scholar
  • 3 Kamei S, Osada D, Tamai K. , et al. Stability of volar locking plate systems for AO type C3 fractures of the distal radius: biomechanical study in a cadaveric model. J Orthop Sci 2010; 15 (03) 357-364
    CrossrefPubMedGoogle Scholar
  • 4 Leung F, Zhu L, Ho H, Lu WW, Chow SP. Palmar plate fixation of AO type C2 fracture of distal radius using a locking compression plate--a biomechanical study in a cadaveric model. J Hand Surg [Br] 2003; 28 (03) 263-266
    CrossrefPubMedGoogle Scholar
  • 5 Osada D, Fujita S, Tamai K, Iwamoto A, Tomizawa K, Saotome K. Biomechanics in uniaxial compression of three distal radius volar plates. J Hand Surg Am 2004; 29 (03) 446-451
    CrossrefPubMedGoogle Scholar
  • 6 Orbay JL. The treatment of unstable distal radius fractures with volar fixation. Hand Surg 2000; 5 (02) 103-112
    CrossrefPubMedGoogle Scholar
  • 7 Lebailly F, Zemirline A, Facca S, Gouzou S, Liverneaux P. Distal radius fixation through a mini-invasive approach of 15 mm. PART 1: a series of 144 cases. Eur J Orthop Surg Traumatol 2014; 24 (06) 877-890
    CrossrefPubMedGoogle Scholar
  • 8 MacDermid JC, Turgeon T, Richards RS, Beadle M, Roth JH. Patient rating of wrist pain and disability: a reliable and valid measurement tool. J Orthop Trauma 1998; 12 (08) 577-586
    CrossrefPubMedGoogle Scholar
  • 9 Simanski CJ, Maegele MG, Lefering R. , et al. Functional treatment and early weight bearing after an ankle fracture: a prospective study. J Orthop Trauma 2006; 20 (02) 108-114
    CrossrefPubMedGoogle Scholar
  • 10 Krettek C, Schandelmaier P, Miclau T, Tscherne H. Minimally invasive percutaneous plate osteosynthesis (MIPPO) using the DCS in proximal and distal femoral fractures. Injury 1997; 28 (Suppl. 01) A20-A30
    CrossrefPubMedGoogle Scholar
  • 11 Lin SJ, Huang KC, Chuang PY. , et al. The outcome of unstable proximal femoral fracture treated with reverse LISS plates. Injury 2016; 47 (10) 2161-2168
    CrossrefPubMedGoogle Scholar
  • 12 Koh S, Morris RP, Patterson RM, Kearney JP, Buford Jr WL, Viegas SF. Volar fixation for dorsally angulated extra-articular fractures of the distal radius: a biomechanical study. J Hand Surg Am 2006; 31 (05) 771-779
    CrossrefPubMedGoogle Scholar
  • 13 Osada D, Viegas SF, Shah MA, Morris RP, Patterson RM. Comparison of different distal radius dorsal and volar fracture fixation plates: a biomechanical study. J Hand Surg Am 2003; 28 (01) 94-104
    PubMedGoogle Scholar
  • 14 Lutz K, Yeoh KM, MacDermid JC, Symonette C, Grewal R. Complications associated with operative versus nonsurgical treatment of distal radius fractures in patients aged 65 years and older. J Hand Surg Am 2014; 39 (07) 1280-1286
    CrossrefPubMedGoogle Scholar
  • 15 Aktekin CN, Altay M, Gursoy Z, Aktekin LA, Ozturk AM, Tabak AY. Comparison between external fixation and cast treatment in the management of distal radius fractures in patients aged 65 years and older. J Hand Surg Am 2010; 35 (05) 736-742
    CrossrefPubMedGoogle Scholar
  • 16 Chan YH, Foo TL, Yeo CJ, Chew WY. Comparison between cast immobilization versus volar locking plate fixation of distal radius fractures in active elderly patients, the Asian perspective. Hand Surg 2014; 19 (01) 19-23
    CrossrefPubMedGoogle Scholar
  • 17 Bartl C, Stengel D, Bruckner T, Gebhard F. ; ORCHID Study Group. The treatment of displaced intra-articular distal radius fractures in elderly patients. Dtsch Arztebl Int 2014; 111 (46) 779-787
    Google Scholar
  • 18 Wong TC, Chiu Y, Tsang WL, Leung WY, Yam SK, Yeung SH. Casting versus percutaneous pinning for extra-articular fractures of the distal radius in an elderly Chinese population: a prospective randomised controlled trial. J Hand Surg Eur Vol 2010; 35 (03) 202-208
    CrossrefPubMedGoogle Scholar
  • 19 Chung KC, Watt AJ, Kotsis SV, Margaliot Z, Haase SC, Kim HM. Treatment of unstable distal radial fractures with the volar locking plating system. J Bone Joint Surg Am 2006; 88 (12) 2687-2694
    CrossrefPubMedGoogle Scholar
  • 20 McQueen MM, Hajducka C, Court-Brown CM. Redisplaced unstable fractures of the distal radius: a prospective randomised comparison of four methods of treatment. J Bone Joint Surg Br 1996; 78 (03) 404-409
    CrossrefPubMedGoogle Scholar
  • 21 Günay C, Öken ÖF, Yavuz OY, Günay SH, Atalar H. Which modality is the best choice in distal radius fractures treated with two different Kirschner wire fixation and immobilization techniques?. Ulus Travma Acil Cerrahi Derg 2015; 21 (02) 119-126
    PubMedGoogle Scholar
  • 22 Milliez PY, Dallaserra M, Defives T, el Ayoubi L, Thomine JM. Effect of early mobilization following Kapandji's method of intrafocal wiring in fractures of the distal end of the radius. Results of a prospective study of 60 cases [in French]. Int Orthop 1992; 16 (01) 39-43
    CrossrefPubMedGoogle Scholar
  • 23 Osada D, Kamei S, Masuzaki K, Takai M, Kameda M, Tamai K. Prospective study of distal radius fractures treated with a volar locking plate system. J Hand Surg Am 2008; 33 (05) 691-700
    CrossrefPubMedGoogle Scholar
  • 24 Quadlbauer S, Pezzei C, Jurkowitsch J. , et al. Early rehabilitation of distal radius fractures stabilized by volar locking plate: a prospective randomized pilot study. J Wrist Surg 2017; 6 (02) 102-112
    Google Scholar
  • 25 MacDermid JC, Roth JH, Richards RS. Pain and disability reported in the year following a distal radius fracture: a cohort study. BMC Musculoskelet Disord 2003; 4: 24
    CrossrefPubMedGoogle Scholar
  • 26 Lozano-Calderón SA, Souer S, Mudgal C, Jupiter JB, Ring D. Wrist mobilization following volar plate fixation of fractures of the distal part of the radius. J Bone Joint Surg Am 2008; 90 (06) 1297-1304
    CrossrefPubMedGoogle Scholar