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Published on: March 13, 2026
Relationship Between Bone Density and Loss of Reduction in Distal Radius Fractures Treated With Volar Locking Plate
Mariano Oscar Abrego1, Fernando Holc1, Pedro Bronenberg Victorica1
1Italian Hospital of Buenos Aires, Argentina.
Background:
Distal radius fractures (DRFs) are common fragility fractures and may be indicators of osteoporosis. The management of these fractures in older people is controversial, with osteoporosis identified as a potential cause of DRF instability. A correlation has been observed between the second metacarpal cortical percentage (2MCP) and bone density, which is essential for understanding postoperative reduction loss. This study aimed to evaluate the relationship between osteoporosis, measured by 2MCP, and loss of reduction in patients older than 65 years with DRFs treated using a volar locking plate (VLP). The secondary aim was to assess factors related to reduction loss.
Methods:
A retrospective analytical cohort study included patients older than 65 years with DRFs treated with VLP between 2017 and 2023. Baseline characteristics and fracture patterns were recorded. Bone density was assessed using 2MCP from preoperative wrist radiographs. Instability was defined by Lafontaine criteria. Radiological parameters (radial inclination, volar tilt, radial height, and ulnar variance) were measured immediately postoperatively and at follow-up (≥12 weeks). Screw lengths and distances between locking screws and the subchondral articular surface were also evaluated. Patients were divided into 2 groups: osteoporosis (2MCP <50%) and non-osteoporosis (2MCP ≥50%). Comparative and logistic regression analyses were performed.
Results:
A total of 315 patients were included, with 256 in the <50% 2MCP group and 59 in the >50% 2MCP group. Patients in the <50% group were older compared with those in the >50% 2MTC group (74.8 vs 72 years). Statistically significant changes were noted in radiographic parameters, but no significant differences were found between groups. Logistic regression revealed associations between screw positioning, fracture severity, and reduction loss.
Conclusions:
This study found no association between 2MCP and loss of reduction in DRFs treated with VLP. Screw positioning and fracture severity were more significant factors than bone density in influencing postoperative reduction loss.
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