Abstract
Purpose: Management of the unstable or comminuted displaced fractures of the distal radius is difficult. We report our experience treating these fractures with AO volar plate fixation. An attempt to introduce a new radiological classification for the accuracy of surgical reduction is made. The classification includes 10 criteria and 100 points.
Methods: 124 patients had volar plate fixation performed between June 2000 and May 2003 using AO volar plate. We reviewed clinically and radiologically 101 patients; 60 were type C and 41 were type A (after failed conservative treatment). The average follow up is 37 months (24 – 57). The average age is 46 years (19 – 81). Postoperative regimen consisted of immediate physiotherapy and a wrist splint for three weeks. Cooney’s modification of Green and O’Brien and Sarmiento’s modification of Gartland and Werley were used for clinical assessment. Lidstorm and Frykman used for radiological assessment.
Results: At final follow up the means of distal radius parameters were: volar tilt of 9 degrees, radial inclination of 22 degrees, radial height is 11mm and palmer cortical angle of 32 degrees. The mean dorsiflexion was 61 degrees, palmer flexion was 59 degrees, pronation was 80 degrees and supination was 76 degrees. Grip strength was 86 percent of the opposite side. The average DASH score was 13.6. There was 14 poor results, 6 of them had significant loss the initial reduction. There was significant correlation between our classification and the clinical outcome.
Conclusion: AO volar plate fixation of unstable distal radius fractures provides strong fixation that maintains reduction and allows early mobilisation.
Correspondence should be addressed to Mr Carlos Wigderowitz, Senior Lecturer, University Department of Orthopaedic and Trauma Surgery, Ninewells Hospital and Medical School, Dundee DD1 9SY.
