The treatment of unstable distal radius fractures remains controversial. Volar locking plates provide stable fixation using the fixed angle device principle. More recently this technique has gained increasing popularity with several reports demonstrating good results. We present our experience from the first 259 patients performed at this institution.

Method: Local Ethics Committee approval was obtained prior to the onset of the study. Theatre records and implant forms were used to recruit all patients in whom a Distal Volar Radius (DVR) Plate, (DePuy, Leeds, United Kingdom) was used for an unstable distal radius fracture between August 2005 and February 2008. Surgery was performed either by a consultant, or a specialist registrar. Two hundred and fifty nine consecutive patients were identified. Six patients had bilateral distal radius fractures. Patient records were reviewed, and each patient contacted via a postal questionnaire and Patient-Rated Wrist Evaluation (PRWE). Other outcome measures included return to work and complication rate.

Results: Of the 259 patients 160 responses were received, response rate 62%. The mean follow up was 30.8 months, (Range 18–48). The mean age of the patients was 57.3 years (Range 16–93). The mean inpatient stay was 1.6 days, (mode 1 day). The median PRWE was 3; (range 0–83) and the mode was 0. Ninety four of the patients had a PRWE of ≤5. Seventy one out of 78 patients (91%) returned to the same job. The mean return to work was 40.6 days (SD37.5).

There were 13 minor complications in total (7.8%). Six patients had extensor tendon irritation, of which two patients required extensor tendon reconstruction. One further patient had a spontaneous EPL rupture which was not associated with prominent metal work. Four (2.4%) patients had median nerve symptoms postoperatively. Two patients subsequently required carpal tunnel decompression, the other two settled spontaneously. Two (1.2%), patients developed Complex Regional Pain Syndrome. One patient developed a minor superficial wound infection.

In all, 9 (5.4%) patients had removal of their metalwork, 6 for tendon irritation, 2 for wrist stiffness (one which was positioned too distally) and 1 for pin penetration into the joint.

Discussion: Our results show that the DVR plate can be used reliably with good results and an early return to high levels of function. This is the largest series to date of the use of this distal volar locking plate.

We have reviewed 22 patients with scaphoid fractures treated by internal fixation with the Herbert screw. Three patients had trans-scaphoid perilunar dislocations, one had an oblique displaced fracture of the waist of the scaphoid and 18 had fractures with delayed or non-union. Corticocancellous bone grafts were added in nine of the cases of non-union. Results were excellent or good in 80% of cases after a mean duration of postoperative immobilisation of four weeks. The technical difficulties are analysed and the problems of applying the jig and of operative exposure are discussed.

Five patients suffered injuries around the wrist complicated by acute tunnel syndrome. Pain associated with median nerve paraesthesia or hypo-aesthesia are indications for urgent treatment; in four patients where operation was delayed, the outcome was poor.