Surgical techniques and effectiveness of volar locking plates for senile delayed distal radius fractures_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

XU Mingjian , XIANG Fuzhou , LI Chunxiao , 苏来提·肖合热提 ,  SHENG Jiagen

Department of Orthopedics, Sixth Affiliated Hospital of Shanghai Jiao Tong University, Shanghai, 200233, P.R.China;

Corresponding author：

SHENG Jiagen, Email: 374050398@qq.com

Keywords：

Delayed distal radius fracture; volar locking plate; internal fixation

DOI：

10.7507/1002-1892.201702039

Video：

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Objective To investigate the surgical technique and effectiveness of volar locking plates for senile delayed distal radius fractures. Methods Between October 2014 and September 2015, 25 cases of delayed distal radius fractures were treated by volar locking plates. There were 3 males and 22 females with an average age of 73 years (range, 65-87 years). Injury was caused by tumble in 19 cases and by traffic accident in 6 cases. All the cases had closed fracture. According to the AO classification, 10 cases were rated as type A2, 7 cases as type A3, 3 cases as type B3, and 5 cases as type C1. The manual reduction and plaster immobilization were performed in 18 cases first, but reduction failed; no treatment was given in 7 cases before surgery. The time from injury to surgery was from 33 to 126 days (mean, 61 days). Preoperatively, the volar tilting angle was (–16.0±3.1)°; the ulnar inclining angle was (10.8±7.0)°; the radial shortening was (11.2±3.6) mm; the wrist range of motion was (41.0±7.5)° in flexion and was (42.0±6.3)° in extension; and the grip strength was 33.0%±3.1% of normal side. Results All incisions healed primarily, and no postoperative complication occurred. The patients were followed up 1-1.5 years (mean, 1.3 years). The X-ray films showed that fracture union was achieved in all the patients, with the mean healing time of 9.2 weeks (range, 8-12 weeks); the displacement of the articular surface was less than 1 mm. At last follow-up, the volar tilting angle was (13.1±3.2)°; the ulnar inclining angle was (21.9±4.6)°; the radial shortening was (2.0±1.1) mm; the wrist range of motion was (52.0±11.7)° in flexion and was (65.0±4.8)° in extension; and the grip strength was 84.0%±4.2% of normal side; all showed significant difference when compared with preoperative ones (P<0.05). According to the Gartland and Werley score, the results were excellent in 15 cases, good in 6 cases, fair in 2 cases, and poor in 2 cases at last follow-up; the excellent and good rate was 84%. Conclusion By the good design of the volar locking plate and the command of surgical techniques, good effectiveness can be achieved in the treatment of senile delayed distal radius fracture.

Citation： XU Mingjian, XIANG Fuzhou, LI Chunxiao, SHENG Jiagen. Surgical techniques and effectiveness of volar locking plates for senile delayed distal radius fractures. Chinese Journal of Reparative and Reconstructive Surgery, 2017, 31(7): 785-789. doi: 10.7507/1002-1892.201702039 Copy

1.	Yamashita K, ZenkeY, SakaiA, et al. Comparison of Functional Outcome Between Early and Delayed Internal Fixation Using Volar Locking Plate for Distal Radius Fractures. J UOEH, 2015, 37(2): 111-119.
2.	Figl M, Weninger P, Jurkowitsch J, et al. Unstable distal radius fractures in the elderly patient-volar fixed-angle plate osteosynthesis prevents secondary loss of reduction. J Trauma, 2010, 68(4): 992-998.
3.	Arora R, Gabl M, Gschwentner M, et al. A comparative study of clinical and radiologic outcomes of unstable colles type distal radius fractures in patients older than 70 years: nonoperative treatment versus volar locking plating. J Orthop Trauma, 2009, 23(4): 237-242.
4.	姜保国, 龙奎元, 张殿英, 等. 桡骨远端骨折的治疗策略. 中华创伤骨科杂志, 2004, 6(10): 1118-1121.
5.	Richard MJ, Katolik LI, Hanel DP, et al. Distraction plating for the treatment of highly comminuted distal radius fractures in elderly patients. J Hand Surg (Am), 2012, 37(5): 948-956.
6.	李书振, 陈跃平, 林宗汉, 等. 切开复位与闭合复位治疗老年桡骨远端骨折的对比研究. 中国修复重建外科杂志, 2010, 24(4): 438-442.
7.	Weil YA, Mosheiff R, Firman S, et al. Outcome of delayed primary internal fixation of distal radius fractures: a comparative study. Injury, 2014, 45(6): 960-964.
8.	Fujii K, Henmi T, Kanematsu Y, et al. Fractures of the distal end of radius in elderly patients: a comparative study of anatomical and functional results. J Orthop Surg (Hong Kong), 2002, 10(1): 9-15.
9.	Choi WS, Lee HJ, Kim DY, et al. Does osteoporosis have a negative effect on the functional outcome of an osteoporotic distal radial fracture treated with a volar locking plate? Bone Joint J, 2015, 97-B(2): 229-234.
10.	Tulipan J, Jones CM, Ilyas AM. The Effect of Osteoporosis on Healing of Distal Radius Fragility Fractures. Orthop Clin North Am, 2015, 46(4): 541-549.
11.	Osti M, Mittler C, Zinnecker R, et al. Locking versus nonlocking palmar plate fixation of distal radius fractures. Orthopedics, 2012, 35(11): e1613-1617.
12.	Choi WS, Lee HJ, Kim DY, et al. Does osteoporosis have a negative effect on the functional outcome of an osteoporotic distal radial fracture treated with a volar locking plate. Bone Joint J, 2015, 97-B(2): 229-234.
13.	Marcheix PS, Dotzis A, Benkö PE, et al. Extension fractures of the distal radius in patients older than 50: a prospective randomized study comparing fixation using mixed pins or a palmar fixed-angle plate. J Hand Surg (EurVol), 2010, 35(8): 646-651.
14.	Schmelzer-Schmied N, Wieloch P, Martini AK, et al. Comparison of external fixation, locking and non-locking palmar plating for unstable distal radius fractures in the elderly. Int Orthop, 2009, 33(3): 773-778.
15.	Schütz M, Südkamp NP. Revolution in plate ostesynthesis: new internal fixator systems. J Orthop Sci, 2003, 8(2): 252-258.
16.	Wong KK, Chan KW, Kwok TK, et al. Volar fixation of dorsally displaced distal radial fracture using locking compression plate. J Orthop Surg (Hong Kong), 2005, 13(2): 153-157.
17.	Chung KC, Shauver MJ, Birkmeyer JD. Trends in the United States in the treatment of distal radial fractures in the elderly. J Bone Joint Surg (Am), 2009, 91(8): 1868-1873.
18.	Giannoudis P, Tzioupis C, Almalki T, et al. Fracture healing in osteoporotic fractures: Is it really different? a basic science perspective. Injury, 2007, 38Suppl 1: S90-99.
19.	Van Lieshout EM, Alt V. Bone graft substitutes and bone morphogenetic proteins for osteoporotic fractures: what is the evidence? Injury, 2016, 47(Suppl 1): S43-46.

1. Yamashita K, ZenkeY, SakaiA, et al. Comparison of Functional Outcome Between Early and Delayed Internal Fixation Using Volar Locking Plate for Distal Radius Fractures. J UOEH, 2015, 37(2): 111-119.
2. Figl M, Weninger P, Jurkowitsch J, et al. Unstable distal radius fractures in the elderly patient-volar fixed-angle plate osteosynthesis prevents secondary loss of reduction. J Trauma, 2010, 68(4): 992-998.
3. Arora R, Gabl M, Gschwentner M, et al. A comparative study of clinical and radiologic outcomes of unstable colles type distal radius fractures in patients older than 70 years: nonoperative treatment versus volar locking plating. J Orthop Trauma, 2009, 23(4): 237-242.
4. 姜保国, 龙奎元, 张殿英, 等. 桡骨远端骨折的治疗策略. 中华创伤骨科杂志, 2004, 6(10): 1118-1121.
5. Richard MJ, Katolik LI, Hanel DP, et al. Distraction plating for the treatment of highly comminuted distal radius fractures in elderly patients. J Hand Surg (Am), 2012, 37(5): 948-956.
6. 李书振, 陈跃平, 林宗汉, 等. 切开复位与闭合复位治疗老年桡骨远端骨折的对比研究. 中国修复重建外科杂志, 2010, 24(4): 438-442.
7. Weil YA, Mosheiff R, Firman S, et al. Outcome of delayed primary internal fixation of distal radius fractures: a comparative study. Injury, 2014, 45(6): 960-964.
8. Fujii K, Henmi T, Kanematsu Y, et al. Fractures of the distal end of radius in elderly patients: a comparative study of anatomical and functional results. J Orthop Surg (Hong Kong), 2002, 10(1): 9-15.
9. Choi WS, Lee HJ, Kim DY, et al. Does osteoporosis have a negative effect on the functional outcome of an osteoporotic distal radial fracture treated with a volar locking plate? Bone Joint J, 2015, 97-B(2): 229-234.
10. Tulipan J, Jones CM, Ilyas AM. The Effect of Osteoporosis on Healing of Distal Radius Fragility Fractures. Orthop Clin North Am, 2015, 46(4): 541-549.
11. Osti M, Mittler C, Zinnecker R, et al. Locking versus nonlocking palmar plate fixation of distal radius fractures. Orthopedics, 2012, 35(11): e1613-1617.
12. Choi WS, Lee HJ, Kim DY, et al. Does osteoporosis have a negative effect on the functional outcome of an osteoporotic distal radial fracture treated with a volar locking plate. Bone Joint J, 2015, 97-B(2): 229-234.
13. Marcheix PS, Dotzis A, Benkö PE, et al. Extension fractures of the distal radius in patients older than 50: a prospective randomized study comparing fixation using mixed pins or a palmar fixed-angle plate. J Hand Surg (EurVol), 2010, 35(8): 646-651.
14. Schmelzer-Schmied N, Wieloch P, Martini AK, et al. Comparison of external fixation, locking and non-locking palmar plating for unstable distal radius fractures in the elderly. Int Orthop, 2009, 33(3): 773-778.
15. Schütz M, Südkamp NP. Revolution in plate ostesynthesis: new internal fixator systems. J Orthop Sci, 2003, 8(2): 252-258.
16. Wong KK, Chan KW, Kwok TK, et al. Volar fixation of dorsally displaced distal radial fracture using locking compression plate. J Orthop Surg (Hong Kong), 2005, 13(2): 153-157.
17. Chung KC, Shauver MJ, Birkmeyer JD. Trends in the United States in the treatment of distal radial fractures in the elderly. J Bone Joint Surg (Am), 2009, 91(8): 1868-1873.
18. Giannoudis P, Tzioupis C, Almalki T, et al. Fracture healing in osteoporotic fractures: Is it really different? a basic science perspective. Injury, 2007, 38Suppl 1: S90-99.
19. Van Lieshout EM, Alt V. Bone graft substitutes and bone morphogenetic proteins for osteoporotic fractures: what is the evidence? Injury, 2016, 47(Suppl 1): S43-46.

Chinese Journal of Reparative and Reconstructive Surgery

Surgical techniques and effectiveness of volar locking plates for senile delayed distal radius fractures

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