Results of volar locking plating for unstable distal radius fractures

The aim of this study was to analyze the complications and functional and radiographic results of volar locking plating in the treatment of unstable distal radius fractures.

Forty-six patients (mean age: 48.7 years) with Type C distal radius fractures were treated with volar locking plates and evaluated over a mean follow-up period of 19 months. Range of motion, strength, DASH questionnaire and MAYO wrist score were assessed. Shortening, inclination and palmar tilt were recorded on standard radiographs and tenosynovitis and tendon ruptures were assessed using ultrasound. The uninjured wrists were examined as controls. Statistical analysis was made using t-tests.

All fractures achieved union. Postoperative MAYO scores revealed 14 excellent results, 11 good, 20 satisfactory and one poor result. The mean postoperative DASH score was 15.9 (range: 0 to 72). Active wrist motion averaged 52.3 degrees of flexion, 57.7 degrees of extension, 79.2 degrees of supination and 79.3 degrees of pronation. Mean grip strength was 82% of the uninjured side and mean loss of radial inclination was 0.6 degrees and palmar tilt was 6.6 degrees as compared to normal side. Carpal tunnel syndrome was observed in one patient, flexor tenosynovitis in one patient, extensor tendon rupture in one patient and extensor tenosynovitis in eleven patients. Functional and clinical limitations were most evident in the patients with tendon tear or tenosynovitis.

Fixation of unstable distal radius fractures with volar locking plates provides sufficient stability, and satisfactory clinical outcomes. However, these systems have complication potential that may limit better outcomes.