Intra- and extra-articular distal radius unstable fractures: comparative analysis of the medium-term results of volar plate surgical treatment
DOI:
https://doi.org/10.1016/j.rccot.2020.04.008Keywords:
radius fractures, fracture fixation, internal, range of motion, articular, hand strengthAbstract
Background: To examine and compare the radiological results and postoperative recovery of the medium-term wrist function in unstable extra- and intra-articular fractures of distal radius, after open reduction with a palmar approach and osteosynthesis with a volar plate.
Materials and methods: Retrospective case control study in 52 patients, divided into groups according to the Orthopaedic Association (AO) classification as extra- or intra-articular fractures. The pre-operative and post-operative radiographs were evaluated to determine the anatomical restoration of the radial length, radial angle, and palmar inclination of the radius. The medium-term results of the active range of motion and the grip strength, as well as the Quick DASH score, were evaluated six months after surgery.
Results: The mean age was 53.7 ± 16.8 (SD) years and 63% were women. Extra-articular fractures were more frequent in women, but intra-articular fractures had a similar distribution by gender (P = .023). The grip strength of the operated hand was 73.7% and 67.5% of the opposite hand in the extra- and intra-articular fractures, respectively. The mean Quick DASH score was 2.36 (SD 2.01) and 4.16 (SD 3.82) in extra- and intra-articular fractures, respectively (P = .111).
Discussion: For unstable distal radius fractures, open reduction with palmar approach and volar plate stabilisation offers satisfactory functional results for both extra-articular and intraarticular fractures, with a slight, but expected, advantage in the former due to its lesser complexity.
Evidence level III: Retrospective comparative study
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References
Geller L, Bernstein M, Carli A, Berry G, Reindl R, Harvey E. Efficacy of different fixation devices in maintaining an initial reduction for surgically managed distal radius fractures. Can J Surg J Can Chir. 2009;52:E161-6.
Chen AC, Cheng CY, Chou YC. Intramedullary nailing for correction of post-traumatic deformity in late-diagnosed distal radius fractures. J Orthop Traumatol. 2017;18:37-42, https://doi.org/10.1007/s10195-016-0422-y
Kennedy SA, Hanel DP. Complex Distal Radius Fractures. Orthop Clin North Am. 2013;44:81-92. https://doi.org/10.1016/j.ocl.2012.08.008
Kumar S, Khan AN, Sonanis SV. Radiographic and functional evaluation of low profile dorsal versus volar plating for distal radius fractures. J Orthop. 2016;13:376-82. https://doi.org/10.1016/j.jor.2016.06.017
Brogan DM, Richard MJ, Ruch D, Kakar S. Management of Severely Comminuted Distal Radius Fractures. J Hand Surg. 2015;40:1905-14. https://doi.org/10.1016/j.jhsa.2015.03.014
Takeuchi N, Hotokezaka S, Okada T, Yuge H, Mae T, Iwamoto Y. Recovery of Wrist Function after Volar Locking Plate Fixation for Distal Radius Fractures. J Hand Surg Asian-Pac Vol. 2016;21:199-206. https://doi.org/10.1142/S2424835516500193
Im J-H, Lee J-Y. Pearls and Pitfalls of the Volar Locking Plating for Distal Radius Fractures. J Hand Surg Asian-Pac Vol. 2016;21:125-32. https://doi.org/10.1142/S242483551640004X
Alluri RK, Hill JR, Ghiassi A. Distal Radius Fractures: Approaches Indications, and Techniques. J Hand Surg. 2016;41:845-54. https://doi.org/10.1016/j.jhsa.2016.05.015
Kreder HJ, Hanel DP, McKee M, Jupiter J, McGillivary G, Swiontkowski MF. Consistency of AO fracture classification for the distal radius. J Bone Joint Surg Br. 1996;78:726-31. https://doi.org/10.1302/0301-620X.78B5.0780726
Boonstra AM, Schiphorst Preuper HR, Reneman MF, Posthumus JB, Stewart RE. Reliability and validity of the visual analogue scale for disability in patients with chronic musculoskeletal pain:. Int J Rehabil Res. 2008;31:165-9. https://doi.org/10.1097/MRR.0b013e3282fc0f93
Beaton DE, Wright JG, Katz JN. Development of the QuickDASH: comparison of three item-reduction approaches. J Bone Joint Surg Am. 2005;87:1038-46. https://doi.org/10.2106/JBJS.D.02060
Xavier CRM, Dal Molin DC, Dos Santos RMM, Dos Santos RDT, Neto JCF. Surgical treatment of distal radius fractures with a volar locked plate: correlation of clinical and radiographic results. Rev Bras Ortop. 2011;46:505-13. https://doi.org/10.1590/S0102-36162011000500005
Roh YH, Lee BK, Noh JH, Oh JH, Gong HS, Baek GH. Factors delaying recovery after volar plate fixation of distal radius fractures. J Hand Surg. 2014;39:1465-70. https://doi.org/10.1016/j.jhsa.2014.04.033
Rozental TD, Blazar PE, Franko OI, Chacko AT, Earp BE, Day CS. Functional outcomes for unstable distal radial fractures treated with open reduction and internal fixation or closed reduction and percutaneous fixation. A prospective randomized trial. J Bone Joint Surg Am. 2009;91:1837-46. https://doi.org/10.2106/JBJS.H.01478
Brehmer JL, Husband JB. Accelerated rehabilitation compared with a standard protocol after distal radial fractures treated with volar open reduction and internal fixation: a prospective, randomized, controlled study. J Bone Joint Surg Am. 2014;96:1621-30. https://doi.org/10.2106/JBJS.M.00860
Lee S-J, Park JW, Kang BJ, Lee JI. Clinical and radiologic factors affecting functional outcomes after volar locking plate fixation of dorsal angulated distal radius fractures. J Orthop Sci Off J Jpn Orthop Assoc. 2016;21:619-24. https://doi.org/10.1016/j.jos.2016.05.007
MacFarlane RJ, Miller D, Wilson L, Meyer C, Kerin C, Ford DJ, et al. Functional Outcome and Complications at 2.5 Years Following Volar Locking Plate Fixation of Distal Radius Fractures. J Hand Microsurg. 2015;7:18-24. https://doi.org/10.1007/s12593-014-0155-1
Rhee PC, Shin AY. Management of Complex Distal Radius Fractures: Review of Treatment Principles and Select Surgical Techniques. J Hand Surg Asian-Pac Vol. 2016;21:140-54. https://doi.org/10.1142/S2424835516400063
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 2:256-66. https://doi.org/10.2106/JBJS.G.00283
Machado DG, da Cruz Cerqueira SA, Rodarte RRP, de Souza Araujo Netto CA, de Mathias MB. Statistical analysis on functional and radiographic results after use of locked volar plate for fractures of the distal radius. Rev Bras Ortop. 2012;47:297-303. https://doi.org/10.1590/S0102-36162012000300004
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;21:316-22. https://doi.org/10.1097/BOT.0b013e318059b993
Knight D, Hajducka C, Will E, McQueen M. Locked volar plating for unstable distal radial fractures: Clinical and radiological outcomes. Injury. 2010;41:184-9. https://doi.org/10.1016/j.injury.2009.08.024
Dillingham C, Horodyski M, Struk AM, Wright T. Rate of Improvement following Volar Plate Open Reduction and Internal Fixation of Distal Radius Fractures. Adv Orthop. 2011;2011:565642, doi: 10.4061/2011/565642. https://doi.org/10.4061/2011/565642
Souer JS, Ring D, Matschke S, Audige L, Marent-Huber M, Jupiter JB. Effect of an Unrepaired Fracture of the Ulnar Styloid Base on Outcome After Plate-and-Screw Fixation of a Distal Radial Fracture:. J Bone Jt Surg-Am Vol. 2009;91:830-8. https://doi.org/10.2106/JBJS.H.00345
Campbell D. Open reduction and internal fixation of intra articular and unstable fractures of the distal radius using the ao distal radius plate. J Hand Surg J Br Soc Surg Hand. 2000;25: 528-34. https://doi.org/10.1054/jhsb.2000.0485
Delgado PJ, Martínez-Capoccini DM, Cervera J. Fracturas del radio distal: encuesta sobre preferencias de manejo y tratamiento. Rev Iberoam Cir Mano. 2015;43:28-37. https://doi.org/10.1016/j.ricma.2015.06.006
Rohde G, Haugeberg G, Mengshoel AM, Moum T, Wahl AK. No long-term impact of low-energy distal radius fracture on healthrelated quality of life and global quality of life: a case-control study. BMC Musculoskelet Disord. 2009;10:106. https://doi.org/10.1186/1471-2474-10-106
Gruber G, Zacherl M, Giessauf C, Glehr M, Fuerst F, Liebmann W, et al. Quality of Life After Volar Plate Fixation of Articular Fractures of the Distal Part of the Radius:. J Bone Jt Surg-Am Vol. 2010;92:1170-8. https://doi.org/10.2106/JBJS.I.00737
