Radiographic Analysis in Extra-Articular and Intra-Articular Distal Radius Fractures Treated with Variable-Angle Volar Locking Plate Fixation

Overview

Journal J Clin Med

Specialty General Medicine

Date 2023 May 27

PMID 37240600

Authors

Pin-Chieh Fang

Tak-Yu-Yubie Lo

Chun-Ying Cheng

Chun-Te Wu

Alvin Chao-Yu Chen

Affiliations

Soon will be listed here.

Abstract

(1) Background: Different distal radial fracture types have different prognosis after fixation. Our study aim is to evaluate the differences in radiographic parameters by using variable-angle volar locking plate (VAVLP) fixation according to extra-articular and intra-articular distal radial fracture. (2) Methods: There are two groups: extra-articular group (21) and intra-articular group (25). Forearm radiographs immediately after surgery and at 3 months after operation were reviewed for analyzing radial height (RH), ulnar variance (UV), radial inclination (RI), volar tilt (VT), tear drop angle (TDA), distal dorsal cortical distance (DDD), and Soong classification (SC). (3) Results: There were no significant differences in the above parameters between two groups at either immediately post-operative or at 3-month follow-up, except for TDA ( = 0.048). Most patients in both groups were at low risk of flexor tendon rupture, except for two cases. We observed a positive correlation between post-operative DDD and 3-month change in the intra-articular group, but not the extra-articular group. (4) Conclusions: Our study demonstrates that VAVLP fixation is effective in maintaining the stability of most radiographic parameters and reduces the risk of tendon rupture in both extra-articular and intra-articular distal radial fractures. Post-operative DDD can be used to predict the degree of subsequent displacement in patients with intra-articular fractures fixed with VAVLP.

Citing Articles

Predictive factors of distal radioulnar joint instability after surgical treatment of distal radius fractures.

Li C, Kong L, Shi X, Zhang Z, Lu J, Zhang B Medicine (Baltimore). 2023; 102(48):e36505.

PMID: 38050192 PMC: 10695496. DOI: 10.1097/MD.0000000000036505.

References

Kreder H, Hanel D, McKee M, Jupiter J, McGillivary G, Swiontkowski M . X-ray film measurements for healed distal radius fractures. J Hand Surg Am. 1996; 21(1):31-9. DOI: 10.1016/S0363-5023(96)80151-1. View

Khatri K, Sharma V, Farooque K, Tiwari V . Surgical Treatment of Unstable Distal Radius Fractures With a Volar Variable-Angle Locking Plate: Clinical and Radiological Outcomes. Arch Trauma Res. 2016; 5(2):e25174. PMC: 5035514. DOI: 10.5812/atr.25174. View

Vosbikian M, Ketonis C, Huang R, Ilyas A . Optimal Positioning for Volar Plate Fixation of a Distal Radius Fracture: Determining the Distal Dorsal Cortical Distance. Orthop Clin North Am. 2015; 47(1):235-44. DOI: 10.1016/j.ocl.2015.08.020. View

Mehrzad R, Kim D . Complication Rate Comparing Variable Angle Distal Locking Plate to Fixed Angle Plate Fixation of Distal Radius Fractures. Ann Plast Surg. 2016; 77(6):623-625. DOI: 10.1097/SAP.0000000000000850. View

Snoddy M, An T, Hooe B, Kay H, Lee D, Pappas N . Incidence and reasons for hardware removal following operative fixation of distal radius fractures. J Hand Surg Am. 2015; 40(3):505-7. DOI: 10.1016/j.jhsa.2014.11.022. View

Andersen D, Blair W, Steyers Jr C, Adams B, Brandser E . Classification of distal radius fractures: an analysis of interobserver reliability and intraobserver reproducibility. J Hand Surg Am. 1996; 21(4):574-82. DOI: 10.1016/s0363-5023(96)80006-2. View

Hevonkorpi T, Launonen A, Huttunen T, Kannus P, Niemi S, Mattila V . Incidence of distal radius fracture surgery in Finns aged 50 years or more between 1998 and 2016 - too many patients are yet operated on?. BMC Musculoskelet Disord. 2018; 19(1):70. PMC: 5834887. DOI: 10.1186/s12891-018-1983-0. View

Goren Y, Sauerbier M, Arsalan-Werner A . Impact of Soong grading on flexor tendon ruptures following palmar plating for distal radial fractures. J Hand Surg Eur Vol. 2019; 45(4):348-353. DOI: 10.1177/1753193419893561. View

Jerrhag D, Englund M, Karlsson M, Rosengren B . Epidemiology and time trends of distal forearm fractures in adults - a study of 11.2 million person-years in Sweden. BMC Musculoskelet Disord. 2017; 18(1):240. PMC: 5457562. DOI: 10.1186/s12891-017-1596-z. View

10.

Lee S, Chun Y, Shin H, Kim S, Choy W . Double-tiered subchondral support fixation with optimal distal dorsal cortical distance using a variable-angle volar locking-plate system for distal radius fracture in the elderly. Orthop Traumatol Surg Res. 2018; 104(6):883-891. DOI: 10.1016/j.otsr.2018.04.009. View

11.

Elerian S, Singh T, A Jagodzinsk N, Norris R, Tan S, Power D . Early Results of a Variable-Angle Volar Locking Plate for Distal Radius Fractures: A Bi-centre Study. Cureus. 2021; 13(9):e18321. PMC: 8549491. DOI: 10.7759/cureus.18321. View

12.

Yamak K, Karahan H, Karatan B, Kayali C, Altay T . Evaluation of Flexor Pollicis Longus Tendon Rupture after Treatment of Distal Radius Fracture with the Volar Plate. J Wrist Surg. 2020; 9(3):219-224. PMC: 7263862. DOI: 10.1055/s-0040-1702931. View

13.

Thuysbaert G, Ringburg A, Petronilia S, Vanden Berghe A, Hollevoet N . Measurement of ulnar variance and radial inclination on X-rays of healed distal radius fractures. With the axis of the distal radius or ulna?. Acta Orthop Belg. 2015; 81(2):308-14. View

14.

Erhart S, Toth S, Kaiser P, Kastenberger T, Deml C, Arora R . Comparison of volarly and dorsally displaced distal radius fracture treated by volar locking plate fixation. Arch Orthop Trauma Surg. 2018; 138(6):879-885. DOI: 10.1007/s00402-018-2925-x. View

15.

Gogna P, Selhi H, Singla R, Devgan A, Magu N, Mahindra P . Dorsally comminuted fractures of the distal end of the radius: osteosynthesis with volar fixed angle locking plates. ISRN Orthop. 2014; 2013:131757. PMC: 4045357. DOI: 10.1155/2013/131757. View

16.

Stanbury S, Salo A, Elfar J . Biomechanical analysis of a volar variable-angle locking plate: the effect of capturing a distal radial styloid fragment. J Hand Surg Am. 2012; 37(12):2488-94. DOI: 10.1016/j.jhsa.2012.09.009. View

17.

Medoff R . Essential radiographic evaluation for distal radius fractures. Hand Clin. 2005; 21(3):279-88. DOI: 10.1016/j.hcl.2005.02.008. View

18.

Soong M, Earp B, Bishop G, Leung A, Blazar P . Volar locking plate implant prominence and flexor tendon rupture. J Bone Joint Surg Am. 2011; 93(4):328-35. DOI: 10.2106/JBJS.J.00193. View

19.

Tang C, Chiow S, Lai S, Chia D . The Effect of Hand Dominance, Age, Gender, Fracture Comminution and ASA Status on Time to Fracture Healing Following Surgical Fixation of Distal Radius Fractures. J Hand Surg Asian Pac Vol. 2022; 27(3):459-465. DOI: 10.1142/S2424835522500461. View

20.

Hoffmann M, Schroeder M, Kossow K, Gruber-Rathmann M, Ruecker A . Radiological dorsal tilt analysis of AO type A, B, and C fractures of the distal radius treated conservatively or with extra-focal K-wire plus external fixateur. Skeletal Radiol. 2012; 41(9):1133-9. DOI: 10.1007/s00256-011-1355-4. View