Volar Locking Plates (VLP) have revolutionised the treatment of distal radius fractures allowing the anatomic reduction and stable fixation of the more comminuted and unstable of fractures. The benefits of this in terms of range of movement (ROM), pain and earlier return to work and daily activities is documented. However we were interested in was what improvements in wrist function patients made from 6 to 12 months after injury? We retrospectively looked at a series of 34 consecutive patients that had undergone VLP fixation through a standard anterior approach followed by early physiotherapy. We documented standard demographics and assessed function in terms of Range of Movement, Grip strength (GS), Modified Gartland and Werley score (MGWS), Patient Rated Wrist Evaluation (PRWE) and the quick DASH questionnaire at six and twelve months Two patients were excluded from analysis as they failed to make both assessments. Of the 32 remaining (26 female:6 male) the mean age was 53.2yrs; range (26–78). On average GS, PGS, VAS function and pain did not improve. There was a modest improvement in Movement; Wrist Flexon-13 deg, Wrist Extension-14deg, Radial Deviation-7deg, Ulnar Deviation-9deg. There was no improvement in pronation and supination. There was little improvement in qDASH, PRWE and mGW Scores with only a mean 1.8, 5.6 and 3.6 point improvement respectively.Methods
Results
Angular stable volar locking plates have become increasingly popular for more comminuted fractures of the distal radius. Newer designs of plates have been thicker in profile and incorporate more options for distal fragment fixation. Although they have been shown to be successful at maintaining reduction to allow early mobilisation the main drawback is from screw cut-out. In our practice we have noticed that the newer style of plates that offer more rigid fixation has lead to more instances of screw cut-out. We aimed to quantify the minimum number of locking pegs and or screws need to maintain the operative reduction. We retrospectively looked at a series of 46 patients that had undergone volar plating. We assessed the fracture severity on pre-operative films (according to AO classification) and compared radiographic parameters (volar tilt VT, radial inclination RI and radial height RH) on post-operative films. We calculated the amount of reduction lost from initial post operative x-rays to radiographs taken when union was confirmed. We compared this to the number of locking units used to fix the distal radius and also the configuration they were inserted, i.e. the number in the radial and middle columns.Background
Method
