Displaced distal radial fractures treated using volar locking plates: maintenance of normal anatomy

The objective is to assess the ability of volar locking plates to maintain fracture reduction when used to treat dorsally displaced extra- and intra-articular distal radial fractures.

This prospective study was conducted over an 12-month period. Consenting patients who had sustained a closed, dorsally displaced distal radial fracture, treated by open reduction and internal fixation using a volar distal radial locking plate were included in the study. Radial inclination, volar tilt, and ulnar variance were measured from radiographs taken at least 3 months after surgery and compared with radiographs of the uninjured side. Only two of the eight participating surgeons have a specialist interest in upper limb surgery.

Thirty-three patients were included in the study. There were 23 women and 10 men. The mean age was 49.5 years (range, 26-82 years). According to the Orthopaedic Trauma Association (OTA) classification, there were 19 Type A, 1 Type B, and 13 Type C fractures. The average restoration of volar tilt was 1-degree angle of under correction with a range of 7.3-degree angle of under correction to 3.7-degree angle of over correction, when compared with the uninjured side. The mean restoration of radial inclination was 1.9-degree angle of under correction with a range of 10-degree angle of under correction to 8.4-degree angle of over correction. As a group, the mean ulnar variance was 0 mm with a range of 2 mm of relative ulnar shortening to 3.5 mm of ulnar prominence when compared with the uninjured side.

In the hands of general trauma surgeons, the volar approach combined with the application of a suitable volar locking plate is a good treatment for restoring and maintaining the anatomy of dorsally displaced intra- and extra-articular distal radial fractures.