215. SHOULD NON-LOCKED PLATS BE ABANDONED FOR THE TREATMENT OF DISTAL FRACTURES OF THE RADIUS? COMPARATIVE STUDY OF 81 PATIENTS

Abstract

Purpose of the study: Both conventional plates (CP) and volar locking plates (VP) are used for the ttreatment of distal fractures of the radius (Crognet 2006, Jupiter 2009). This was a retrospective analysis to compare the respective results of these two plating methods with a one year follow-up and to study the clinical outcomes and quality and duration of the reduction achieved.

Material and methods: From 2005 to 2008, 48 CP and 33 VP were inserted for the same indications, simultaneously in the same unit. The four operators chose the material as needed. The time to treatment was less than 12 hours for 81% of patients. For CP, the fractures were comminutive in 60%, articular in 40% and associated with ligament injury for more than 10%. For VP, the fractures were comminutive in 80%, articular in 86% and in a context of multiple trauma in 20%. The clinical analysis included range of motion, index of reduction (IR), stability (IS) and efficacy (IF) defined at the SOFCOT symposium.

Results: For the two series, the mean range of motion was flexion-extension 118, pronosupination 166; the recovered force was > 75% of the controlateral side. The QuickDash was excellent in more than 75%, good in 10%, fair in 10%, poor in 5%. More than 75% had an anatomic result. Complications were the same in percentage and in type for the two types of plates with no significant difference. For the VP, 95% of the clinical and radiographic outcomes were good or very good. For the CP, the results were the same. There was only one real loss of reduction with migration of an epiphyseal screw with no observable clinical impact.

Discussion: This study was limited by the non randomization; there was a difference in the type of injury between the two series. Use of non-locked plates for fractures of the distal radius has proven efficacy as amply noted in the literature. This was analysed, and in particular with a few comparative CP/VP studies. Locking the volar plate does not guarantee stability in fragile cancellous bone. The problems encountered when removing the VP were not within the scope of this work. The cost of locking can limit systematic use. These two types of plates should not be considered in opposition but rather as complementary techniques.