Functional Outcome of Fixation of Complex Intra-articular Distal Radius Fractures with a Variable-Angle Distal Radius Volar Rim Plate

Abstract

Aim To evaluate the outcome of these complex fractures using a volar approach and the DePuy Synthes variable-angle 2.4-mm distal radius rim plate. This plate is precontoured to the volar rim for placement distal to the watershed line allowing purchase of the rim fragment of the lunate facet. Its low profile and smooth edges are designed to minimize flexor tendon irritation.

Method We report on a consecutive series of far distal AO-23B3 and AO-23C3 fractures treated using this plate in a tertiary hand center between November 2011 and May 2014. Range of motion, grip strength, and complications were assessed at the final clinical review. Disabilities of the arm, shoulder, and hand (DASH) and patient evaluation measure (PEM) scores were assessed at 12 months after surgery.

Results Twenty-six patients were included in this review. Six patients were lost to follow-up at 3 months. This plate was used in isolation in 17 cases, and in combination with a dorsal plate, in cases of dorsal instability after volar plating, in 10 patients. DASH and PEM scores 1 year after surgery were 17.6 and 27%, respectively. Visual analog scores for patient treatment satisfaction and severity of pain showed good satisfaction with treatment and mild intermittent pain on activity. Postoperative range of motion was variable and grip strength was of 71% of the uninjured contralateral side. There were no cases of flexor or extensor tendon rupture. Tendon irritation was noted in two patients. Removal of metal was performed in four patients. Loss of reduction occurred in one case and neurologic complications in two cases.

Conclusion This implant is specifically designed for the management of far distal complex intra-articular fractures of the distal radius. Despite the complexity of these fracture patterns and the challenge they pose to accurate reduction and stable fixation, outcomes were satisfactory in this small series. There were no cases of tendon rupture. Removal of metal is not necessary in all cases, but prompt removal should be performed in cases of tendon irritation in view of the risk of tendon rupture.

Keywords

distal radius fracture - open reduction and internal fixation - patient evaluation measure - variable-angle distal radius rim plate

Note

There were no funding, research grants, or conflict of interest for any of the authors for this study.

This study does not involve research with human participants. The data and outcome measures used in the study were collected with the patients' informed consent as part of their routine follow-up clinic appointment after surgery to treat their injuries.

• References

• 1 Jupiter JB, Marent-Huber M. Operative management of distal radial fractures with 2.4-millimeter locking plates. A multicentre prospective case series. J Bone Joint Surg Am 2010; 92 (1) 96-106
• 2 Chen NC, Jupiter JB, Jupiter J. Management of distal radial fractures. J Bone Joint Surg Am 2007; 89 (9) 2051-2062
• 3 O'Shaughnessy MA, Shin AY, Kakar S. Volar marginal rim fracture fixation with volar fragment-specific hook plate fixation. J Hand Surg Am 2015; 40 (8) 1563-1570
• 4 Forward DP, Sithole JS, Davis TR. The internal consistency and validity of the patient evaluation measure for outcomes assessment in distal radius fractures. J Hand Surg Eur Vol 2007; 32 (3) 262-267
• 5 Melone Jr CP. Articular fractures of the distal radius. Orthop Clin North Am 1984; 15 (2) 217-236
• 6 Karantana A, Downing ND, Forward DP , et al. Surgical treatment of distal radial fractures with a volar locking plate versus conventional percutaneous methods: a randomized controlled trial. J Bone Joint Surg Am 2013; 95 (19) 1737-1744
• 7 Costa ML, Achten J, Parsons NR , et al; DRAFFT Study Group. Percutaneous fixation with Kirschner wires versus volar locking plate fixation in adults with dorsally displaced fracture of distal radius: randomised controlled trial. BMJ 2014; ; 349.
• 8 Beck JD, Harness NG, Spencer HT. Volar plate fixation failure for volar shearing distal radius fractures with small lunate facet fragments. J Hand Surg Am 2014; 39 (4) 670-678
• 9 Lozano-Calderón SA, Doornberg J, Ring D. Fractures of the dorsal articular margin of the distal part of the radius with dorsal radiocarpal subluxation. J Bone Joint Surg Am 2006; 88 (7) 1486-1493
• 10 Twigt B, Bemelman M, Lansink K, Leenen L. Type C distal radial fractures treated with conventional AO plates: an easy and cost-saving solution in a locking plate era. Int Orthop 2013; 37 (3) 483-488
• 11 Braziulis K, Rimdeika R, Kregždytė R, Tarasevičius S. Associations between the fracture type and functional outcomes after distal radial fractures treated with a volar locking plate. Medicina (Kaunas) 2013; 49 (9) 399-402
• 12 Swart E, Nellans K, Rosenwasser M. The effects of pain, supination, and grip strength on patient-rated disability after operatively treated distal radius fractures. J Hand Surg Am 2012; 37 (5) 957-962
• 13 Arora R, Lutz M, Hennerbichler A, Krappinger D, Espen D, Gabl M. Complications following internal fixation of unstable distal radius fracture with a palmar locking-plate. J Orthop Trauma 2007; 21 (5) 316-322
• 14 Souer JS, Ring D, Jupiter J, Matschke S, Audigé L, Marent-Huber M ; LCP Distal Radius Study Group. Comparison of intra-articular simple compression and extra-articular distal radial fractures. J Bone Joint Surg Am 2011; 93 (22) 2093-2099
• 15 Soong M, Earp BE, Bishop G, Leung A, Blazar P. Volar locking plate implant prominence and flexor tendon rupture. J Bone Joint Surg Am 2011; 93 (4) 328-335
• 16 Cross AW, Schmidt CC. Flexor tendon injuries following locked volar plating of distal radius fractures. J Hand Surg Am 2008; 33 (2) 164-167
• 17 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 (7) 1280-1286
• 18 Drobetz H, Kutscha-Lissberg E. Osteosynthesis of distal radius fractures with a volar locking screw plate. Int Ortho 2003; 27: 1-6
• 19 Dumont C, Fuchs M, Folwaczny EK, Heuermann C, Stürmer KM. [Results of palmar T-plate osteosynthesis in unstable fractures of the distal radius] [in German]. Chirurg 2003; 74 (9) 827-833
• 20 Krimmer H, Pessenlehner C, Hasselbacher K, Meier M, Roth F, Meier R. [Palmar fixed angle plating systems for instable distal radius fractures] [in German]. Unfallchirurg 2004; 107 (6) 460-467
• 21 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
• 22 Wei J, Yang TB, Luo W, Qin JB, Kong FJ. Complications following dorsal versus volar plate fixation of distal radius fracture: a meta-analysis. J Int Med Res 2013; 41 (2) 265-275