Volar locking plate fixation for distal radius fractures: did variable-angle plates make difference?

Two different locking plate designs are now being used for volar plating of the distal radius fractures based on the freedom of screw direction; the fixed-angle, and the variable-angle (polyaxial) plates. We investigated the clinical and radiographic outcomes of both designs.

We reviewed 96 patients with 113 unstable distal radius fractures that were operated on with volar locking plates. The patients' mean age was 41 years. Fixed-angle volar locking plates were utilized in 65 fractures and variable-angle volar locking plates in 48 fractures through modified Henry approach or extended carpal tunnel approach. Full clinical and radiographic evaluation was done for all patients with a mean follow-up of 14 months.

All patients had acceptable clinical and radiographic parameters. The overall functional results (Mayo score, Quick Disability of Arm, Shoulder, and Hand (Q-DASH) score, Range of motion (ROM), and grip strength) were in favor of the variable-angle plate. The radiographic parameters were better with the variable-angle group. The variable-angle group recorded less operative time but more mean image intensifier exposure time. There were two cases of flexor tendon rupture with the fixed-angle group. Fixation with the fixed-angle system needed K-wire augmentation more than the variable-angle group. There was a positive correlation between hand dominance and the final score.

Distal radius volar locking plates yield satisfactory results comparable among different designs. In our series, the variable-angle system showed slightly better function and radiographic outcomes. Supplementary K-wires were needed more frequently with the fixed-angle system.