Prospective evaluation of distal radius fractures treated with variable-angle volar locking plates

To evaluate the radiographic, objective (range of motion and grip strength), and subjective outcomes of variable-angle volar locking plate (VAVLP) fixation for unstable distal radius fractures.

Over a 12-month period, we prospectively evaluated 39 consecutive distal radius fractures treated operatively with VAVLPs. Surgical exposure, fracture reduction, plate application, and postoperative rehabilitation were uniformly performed. Clinical outcome and radiographic measures, with a minimum follow-up of 12 months, were obtained.

Final follow-up data were available in 37 patients (26 females and 11 males) with average age of 57 years (range, 16-89 y). The average follow-up time was 14 months (range, 12-22 mo). At final evaluation, average volar tilt was 3°, average radial inclination was 21°, average radial height was 12 mm, and average ulnar variance was -0.2 mm. There was no statistical difference between first postoperative and 1-year follow-up radiographs for any of the measured variables, although there were 4 cases of loss of volar tilt. Average Disabilities of the Arm, Shoulder, and Hand score was 6 and average visual analog scale pain score was 0.3. Mean grip strength at 1 year was 96% of the contralateral side. There was 1 case of variable-angle locking screw loosening and 1 case of extensor tenosynovitis requiring hardware removal. There were no tendon ruptures.

The VAVLP fixation restored and maintained acceptable reduction in all patients in this series with a complication rate comparable to standard volar fixed-angle locking plates. Treatment of unstable distal radius fractures with a VAVLP resulted in excellent clinical outcomes at 1-year follow-up. However, use of the VAVLP risks soft tissue irritation, hardware failure, and loss of fracture reduction.

Therapeutic IV.