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Combined Plating of Intra-Articular Distal Radius Fractures, a Consecutive Series of 74 Cases
Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Hand Surgery.ORCID iD: 0000-0002-5083-3591
Örebro University, School of Medical Sciences. Department of Hand Surgery.ORCID iD: 0000-0002-4288-3134
Department of Hand Surgery, Faculty of Medicine and Health, Örebro University, SE, Örebro, Sweden.
2020 (English)In: Journal of wrist surgery, ISSN 2163-3916, E-ISSN 2163-3924, Vol. 9, no 5, p. 388-395Article in journal (Refereed) Published
Abstract [en]

Background: The distal radius fracture (DRF) is themost common fracture in adults. For unstable intra- articular fractures, the choice of treatment is often operative. The optimal choice of fixation remains a matter of discussion.

Question/Purpose: Can combined volar and dorsal plating, using a dorsal frame plate, achieve a good functional and radiographic 1-year outcome in intra-articular DRFs? Methods In a retrospective cohort study, we evaluated 74 consecutive patients operated with combined plating using a volar plate and a dorsal frame plate. The DRFs were operated between 2016 and 2017 and all cases were AO type C intraarticular fractures. The primary outcome was patient- reported outcome measures including radiographic examination 1 year postoperatively. Secondary outcome measures included wrist range of motion, visual analog scale (VAS) pain scores, and hand grip strength.

Results: The median patient-rated wrist evaluation score was 18 points; the quick disabilities of the arm, shoulder, and hand score was 14.8 points. The median Batra radiographic score was 88. Wrist extension was 76% of the uninjured side, flexion was 74%, pronation was 94%, and supination was 94%. VAS pain scores were 0 at rest and 2 during activity. Hand grip strength was 82% compared with the uninjured side. The radiographic outcome according to Batra did not correspond to the patient-reported outcome. Patients older than 60 years had significantly better QuickDASH (quick disabilities of the arm, shoulder, and hand) and PRWE scores (patient-rated wrist evaluation scores) and less pain during activity compared with younger patients despite similar radiographic outcome. There were no tendon ruptures; hardware removal was performed in 21 of the 74 patients.

Conclusion: The radiographic outcome did not correspond to the functional outcome 1 year postoperatively. Older patients report less pain and better functional outcome compared with younger patients. There were no tendon ruptures and the frequency of hardware removal was acceptable. Complex intra-articular DRFs AO type C can be managedwith volar and dorsal frame-plate fixation to restore distal radius anatomy and achieve a good functional outcome.

Place, publisher, year, edition, pages
Thieme Medical Publishers, 2020. Vol. 9, no 5, p. 388-395
Keywords [en]
Distal radius fracture, plating, range of motion, visual analog scale
National Category
Orthopaedics
Identifiers
URN: urn:nbn:se:oru:diva-86475DOI: 10.1055/s-0040-1712503ISI: 000574158600004PubMedID: 33042641OAI: oai:DiVA.org:oru-86475DiVA, id: diva2:1476307
Available from: 2020-10-14 Created: 2020-10-14 Last updated: 2022-11-09Bibliographically approved
In thesis
1. Distal radius fractures AO type C: A clinical and radiographic investigation
Open this publication in new window or tab >>Distal radius fractures AO type C: A clinical and radiographic investigation
2022 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The function of the hand is of substantial importance, and injuries have an impact on daily life. Distal radius fracture (DRF) is the most common fracture among adults. The annual incidence is 26 per 10,000 inhabitants, and the incidence is increasing because of an aging population. There has been a shift from conservative and other operative treatments, toward volar plate fixation to restore the anatomy and improve results. Operative treatment is often considered for displaced and unstable fractures. The optimal choice of treatment and fixation is still debated. The aim of this thesis was to study results after internal fixation of DRF AO type C.

Study I (retrospective study, n=74) assessed outcomes after combined plating (CP) of DRFs AO type C, with 1-year follow-up. CP restored the anatomy and achieved a good functional outcome. The radiographic outcome did not correspond to the clinical or functional outcome.

Study II (prospective study, n=97) assessed the prevalence of post-traumatic arthritis (PA) following CP of DRFs AO type C. CP yielded a good clinical outcome 7 years postoperatively and the prevalence of PA was low (29%). The presence of PA did not correlate with fracture group, radio-graphic, clinical, or functional outcome. 

Study III (randomized controlled trial, n=147) assessed the radiographic and clinical outcome following surgical treatment of DRFs AO type C, comparing volar plating (VP) with CP. Fixation with VP yieldedthe same radiographic and functional results as CP, but with a lower frequency of complications in the VP group.

Study IV (prospective pilot study, n=10) assessed fragment migration with CTMA (CT-based micromotion analysis) after osteosynthesis with VP after DRF AO type C. The CTMA technique indicated that variable angle volar locking plate fixation can yield and maintain a stable reduction of the fracture fragments. CT volume registration could be a valuable tool in the detailed assessment of fracture fragment migration following VP fixation of DRFs. 

Place, publisher, year, edition, pages
Örebro: Örebro University, 2022. p. 93
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 272
Keywords
Distal radius fracture, patient-reported outcome measures, functional outcome, radiographic outcome, plating, volar locking plate, combined plating, surgical treatment, post-traumatic arthritis, wrist
National Category
Surgery
Identifiers
urn:nbn:se:oru:diva-101432 (URN)9789175294742 (ISBN)
Public defence
2022-12-02, Örebro universitet, Campus USÖ, hörsal C1, Södra Grev Rosengatan 32, Örebro, 09:00 (Swedish)
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Available from: 2022-09-23 Created: 2022-09-23 Last updated: 2022-11-14Bibliographically approved

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Sagerfors, MarcusLundqvist, Eva

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