DISTAL RADIAL FRACTURES – ANALYSIS OF PREDICTORS OF OUTCOME OF DISTAL RADIAL VOLAR LOCKING PLATING

Abstract

Introduction: Distal radial volar locking plating systems (DRVLP) are commonly used for complex fractures of the distal radius in all ages.

There have been few studies in the current literature that analyse the success of volar locking plating systems. Those studies with functional outcome and complications data have yet to be

The purpose of the study is assess whether the surgeon can predict which fractures will have a good versus a poor outcome in terms of clinical, radiological and functional outcome assessment.

Method: Patients who sustained a distal radial fracture managed with a radial volar locking plate were identified from hospital audit data systems, after appropriate research ethical approval.

Retrospective data was collected on all patients from patient case notes, radiographs performed pre- and postoperatively and functional data by completed patient rated wrist evaluation scores (PRWE).

Demographic, clinical, radiographic and functional data was collected and statistically analysed by a bio-statistician.

Results: 153 patients were included (116 female, 38 male). Patients were included from all 11 surgeons at the Geelong Hospital between November 2004 and February 2008.

The age range was 17 to 91 years. Average age was 53.7 years at time of injury.

24% patients had concomitant other injuries.

In terms of AO fracture classification 53% patients had type C1 – C3 fractures.

147 patients had the AO Synthes DRVLP, 6 patients had other volar locking plate systems. 27% patients had an exogenous bone graft insertion.

The major complication rate was 12% (18/153) with 94% of these cases requiring further surgery. Post operative radiographs demonstrated an average increase in ulnar variance by 1.25mm, radial inclination by 7 deg, radial length by 4mm and radial tilt by 16 deg (volar angulation) compared to pre-operative radiographs that was statistically significant. 90% patients returned a PRWE form and

Discussion: Predictive parameters for a poor functional outcome were: men, dominant hand injury, other concomitant injuries, pre operative reduced inclination and volar tilit & high ulnar variance on radiographs. Poor functional outcome correlated with poor radiological outcome