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
Despite the variety of implants or techniques that exist to treat displaced distal radial fractures, the majority fail to provide sufficient stability to permit early functional recovery. However, locking plates have the advantage over other implants in that locking screws add considerably to the overall stability. The aim of this study was to assess the functional outcome of patients with displaced distal radial fractures treated with a volar distal radial locking plate (Synthes). During a two year period, details of 98 patients admitted to our unit with inherently unstable dorsally displaced distal radial fractures treated with volar locking plates were collected prospectively. For the purpose of this analysis, only those patients (55) with unilateral fracture, able to attend the study clinic at 6 months post-injury were considered. Patients were immobilised in wool and crepe for a 2 week period. The group consisted of 15 males and 40 females with an average age of 54 (28 to 83). At 6 months, patients' perceived functional recovery averaged 80%. Objective assessment was considered in relation to the uninjured side: grip strength 73%; pinch strength 83%; palmarflexion 77%, dorsiflexion 80%; radial deviation 74%; ulnar deviation 74%; pronation 93%, and supination 92%. Seven patients complained of symptoms relating to prominent metalwork. Good/excellent early subjective and objective functional recovery was made following open reduction and internal fixation using volar locking plates of dorsally displaced distal radial fractures. We suggest that objective assessment of grip strength and dorsiflexion can be used as a measure of patient perception of function.
