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 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 30  |  Issue : 1  |  Page : 15-18

Functional outcome of open reduction and internal fixation of intra-articular distal radial fractures by volar locking plate


Department of Orthopaedics, Orthocare Hospital, Bettiah, Bihar, India

Date of Submission03-Mar-2022
Date of Acceptance09-May-2022
Date of Web Publication30-Jun-2022

Correspondence Address:
Upendra Kumar
Department of Orthopaedics, Orthocare Hospital, Bettiah, Bihar
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijors.ijors_2_22

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  Abstract 

Background: Intra-articular fracture of the distal end of the radius can be treated by various methods. The purpose of this study is to evaluate the functional outcomes of open reduction and internal fixation (ORIF) by volar locking plate (VLP) of intra-articular distal radial fractures. Materials and Methods: This is a single centre retrospective study conducted from April 2017 to May 2019 on adult patients having intra-articular distal radius fractures, who were treated by ORIF with VLP. As per medical records, the number of such patients for the study was 12. The fractures were classified as per the Frykman classification system. After operation, patients were followed up for a minimum of 24 weeks. Functional evaluation of the patients was done at the last follow-up according to the demerit point system of Gartland and Werley. Results: Twelve adult patients of intra-articular distal radius fractures were analysed retrospectively for functional outcomes of ORIF with VLP. The age ranged from 22 to 54 years, and males outnumbered females by a ratio of 2:1. The commonest mode of injury was found to be road traffic accidents (75%). The fractures were classified as per the Frykman classification system. Type III was the most common (50%), followed by Type IV (25%). The majority of the cases (58.3%) were operated in 2–5 days following injury. The mean time for union was 8 weeks. Functionally 11 (91.3%) patients had satisfactory (excellent + good) result at the final follow-up. Conclusion: ORIF with volar locking plate is a reliable, efficient, and rewarding procedure for intra-articular fracture of distal radius as it allows stable fixation with restoration of anatomy and function.

Keywords: Distal radius fractures, intra-articular fracture, ORIF, volar locking plate


How to cite this article:
Kumar U. Functional outcome of open reduction and internal fixation of intra-articular distal radial fractures by volar locking plate. Int J Orthop Surg 2022;30:15-8

How to cite this URL:
Kumar U. Functional outcome of open reduction and internal fixation of intra-articular distal radial fractures by volar locking plate. Int J Orthop Surg [serial online] 2022 [cited 2022 Aug 11];30:15-8. Available from: https://www.ijos.in/text.asp?2022/30/1/15/348191




  Introduction Top


About one-sixth of all fractures accounts for distal radius fracture.[1],[2] They can be intra-articular or extra-articular, depending on the pattern of involvement of the distal radioulnar and radiocarpal joint. According to the direction of displacement of the fracture fragments, they have been given different names such as Colles, Barton, or Smith fracture.[3],[4],[5] Anatomical reduction and proper retention of such fractures are utmost important to achieve good functional outcomes, particularly in intra-articular fractures which almost always require open reduction and internal fixation (ORIF).[6],[7] We present the functional outcomes of intra-articular distal radial fractures treated by ORIF using volar locking plate (VLP).


  Materials and Methods Top


A retrospective study was conducted from April 2017 to May 2019 for a total of 12 cases of intra-articular distal radius fractures in adults. Patients below the age of 18 years, unfit for surgery due to associated medical problems and with pathological fractures, were not considered in our study.

After detailed history and a thorough clinical examination, standard radiographs in anteroposterior, lateral, and oblique views were taken for confirmation of the diagnosis. The fracture fragments were analysed and involvement of radiocarpal and distal radioulnar joints was assessed and classified according to the Frykman classification.[8] The limb was initially immobilized with a below elbow POP (Plaster of Paris) slab.

Surgical technique

All cases were operated under general anaesthesia, under tourniquet control by a volar radial approach (Henry) which uses the interval between the flexor carpi radialis and the radial artery. Under image intensifier, reduction was performed and after satisfactory reduction, definitive fixation was done by the volar locking plate. Most of the fractures had a two-part volar Barton fracture or its variant, which was reduced and fixed nicely. Frykman type 4, 6, and 8 fracture and position/reduction of ulnar styloid fracture were also checked, and none of the case required fixation of the ulnar styloid fracture. After fixation of the fracture, wound cleaned, closed, and dressed and below elbow plaster slab applied. Post-operative check X-rays were taken in both PA and lateral views. Wound was inspected on the 3rd post-operative day. Sutures were removed at 10th to 12th post-operative day. The plaster slab was removed after 2 weeks, elastocrepe bandage applied, and active exercises of the wrist started.

The patients were followed up for a minimum of 24 weeks. Clinical and radiological evaluations were performed at periodic intervals during follow-up. Functional evaluation of the patients was done at the last follow-up, according to the demerit point system of Gartland and Werley.[9]


  Results Top


Twelve adult patients of intra-articular distal radius fractures were analysed retrospectively for functional outcomes of ORIF with VLP. The demographic data of all patients/subjects are shown in [Table 1], with the age ranging from 22 to 54 years with an average of 34 years. Males outnumbered females by a ratio of 2:1. The commonest mode of injury was found to be road traffic accidents (75%). The fractures were classified as per the Frykman classification system, and Type III was the most common (50%) in this study. Out of the 12 patients, 4 (33%) had some associated injuries or other fractures, which were managed appropriately. Majority of the cases (66%) were operated in 2–5 days following injury. All the cases were followed up for a minimum period of 24 weeks, and the mean time for union was 8 weeks.
Table 1: General demographic data of patients/subjects

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Functional evaluation of the patients was done at the last follow-up according to the modified demerit point system of Gartland and Werley. Functionally eight patients (66%) had excellent, three had good (25%), and one had fair (8.3%) restoration of functions. Thus, 91.3% of the patients had satisfactory (excellent + good) results in terms of radiological union [Figure 1] and post-operative recovery with hand function [Figure 2] at the final follow-up.
Figure 1: Pre-operative radiographs (anteroposterior and lateral views) of intra-articular distal radial fracture in a 41-year-old male (A) which was fixed by volar locking plate, showing excellent bony union in post-operative (14 weeks follow-up) radiograph of the same patient in anteroposterior (B) and lateral (C) views

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Figure 2: Clinical photographs of the same patient showing early post-operative immobilization (A), then removal of plaster slab after 3 weeks (B) and at last follow-up with excellent results of wrist movements showing palmer flexion (C), dorsiflexion (D)

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No intra-operative complication was noted in our study. One case of superficial infection was noted which took long time to heal and later presented with joint stiffness resulting in fair functional outcomes.


  Discussion Top


The distal end of the radius fractures occurs in the old age population due to osteoporosis and in the young population due to high-velocity injuries.[10] Various treatment modalities have been discussed in the literature for distal radius fractures ranging from closed reduction and cast immobilization to open reduction and internal fixation with variable angle locking plates and even fragment-specific fixation with plates. However, there remains a lot of controversy when it comes to the gold standard treatment.[11] Intra-articular fractures of distal radius almost always require ORIF for which various types of implants are used. VLP is one of the implants which provide relatively stable construct in terms of rigidity and anatomically compared with conventional non-locking volar plates, dorsal plates, or external fixation.[12],[13]

The average age of the patients in our study was 34 years, which was almost comparable with the study conducted by Ansari et al.,[14] in which the average age was 39 years. Males were most commonly affected in our study, comparable to the study conducted by other authors as well.[14],[15] In our study, we found preponderance of distal radius fractures in male patients (8 out of 12), which is similar to other studies by Jupiter et al.[16] (29 out of 49) and Tang et al. (19 out of 33).[17]

Most cases in our series had dominant right hand and involved in 8 cases (66%) which is comparable and consistent with other studies (Jupiter et al.[16]: 61.2% right side). The mode of injury in our study was mostly due to road traffic accidents (70%), which is comparable with studies of Tang et al.[17] Majority of the cases (66%) were operated in 2–5 days following injury. All the cases were followed up for a minimum period of 24 weeks and the mean time for union was 8 weeks which is comparable with the mean time for union of 8.8 in the study conducted by Agarwal and Nagi.[18]

Functionally 11 patients (91.3%) had satisfactory results in this series, which is comparable to Jupiter et al.[16] (83.7%) and Tang et al.[17] (94.1%). Concerning complications in our study, all, except one, patients were free from any complication. One patient developed superficial wound infection that was managed with an oral antibiotic and regular dressing, but caused secondary complication of stiffness of joints leading to fair results.


  Conclusion Top


To conclude, ORIF with VLP is a reliable, efficient, and rewarding procedure for intra-articular fracture of distal radius as it allows stable fixation with restoration of anatomy and function.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Goel A, Daga S, Bhowal S, Sen B, Barman R, Keshkar S. Functional outcome of open reduction and internal fixation of intra-articular distal radial fractures by buttress plate. J Orthop Traumatol Rehabil 2020;12:138-42.  Back to cited text no. 1
  [Full text]  
2.
Jakim I, Pieter HS, Sweet MBE. External fixation for intraarticular fracture of distal radius. J Bone Joint Surg (Br) 1991;73:302-6.  Back to cited text no. 2
    
3.
Colles A. Fracture of the carpal extremity of the radius. Edinb Med Surg J 1814;10:182-6.  Back to cited text no. 3
    
4.
de Oliveira JC. Barton’s fractures. J Bone Joint Surg Am 1973;55:586-94.  Back to cited text no. 4
    
5.
Ellis J. Smith’s and Barton’s fractures—A method of treatment. J Bone Joint Surg 1965;47-B:724-7.  Back to cited text no. 5
    
6.
Jupiter JB. Current concepts and review of fracture of distal end radius. J Bone Joint Surg (Am) 1991;292:48-61.  Back to cited text no. 6
    
7.
Knirk JL, Jupiter JB. Intra-articular fractures of the distal end of the radius in young adults. J Bone Joint Surg Am 1986;68:647-59.  Back to cited text no. 7
    
8.
Frykman GK. Fracture of the distal radius including sequelae shoulder hand finger syndrome, disturbance in the distal radioulnar joint and impairment of nerve function—A clinical and experimental study. Acta Orthop Scand Suppl 1967;108:1-155.  Back to cited text no. 8
    
9.
Gartland JJ Jr, Werley CW. Evaluation of healed Colles’ fractures. J Bone Joint Surg Am 1951;33-A:895-907.  Back to cited text no. 9
    
10.
Phadnis J, Trompeter A, Gallagher K, Bradshaw L, Elliott DS, Newman KJ. Mid-term functional outcome after the internal fixation of distal radius fractures. J Orthop Surg Res 2012;7:4.  Back to cited text no. 10
    
11.
Costa ML, Achten J, Parsons NR, Rangan A, Edlin RP, Brown J, et al. UK Draft—A randomised controlled trial of percutaneous fixation with Kirschner wires versus volar locking-plate fixation in the treatment of adult patients with a dorsally displaced fracture of the distal radius. BMC Musculoskelet Disord 2011;12:201.  Back to cited text no. 11
    
12.
Levin SM, Nelson CO, Botts JD, Teplitz GA, Kwon Y, Serra-Hsu F. Biomechanical evaluation of volar locking plates for distal radius fractures. Hand (NY) 2008;3:55-60.  Back to cited text no. 12
    
13.
Leung F, Zhu L, Ho H, Lu WW, Chow SP. Palmar plate fixation of AO type C2 fracture of distal radius using a locking compression plate—A biomechanical study in a cadaveric model. J Hand Surg Br 2003;28:263-6.  Back to cited text no. 13
    
14.
Ansari E, Tank PM, Chawda RV, Patel VJ, Patel NB. Surgical treatment of distal end of radius fracture with volar locking plate: Clinicoradiological outcome of 25 cases. Indian J Orthop Surg 2018;4:264-9.  Back to cited text no. 14
    
15.
Pradhan R, Sharma S, Pandey B, Manandhar R, Lakhey S, Rijal K. Osteosynthesis of unstable fractures of distal radius with volar locking plate. Nepal Orthop Assoc J 2013;2:27-34.  Back to cited text no. 15
    
16.
Jupiter JB, Fernandez DL, Toh CL, Fellman T, Ring D. Operative treatment of volar intra-articular fractures of the distal end of the radius. J Bone Joint Surg Am 1996;78:1817-28.  Back to cited text no. 16
    
17.
Tang Z, Yang H, Chen K, Wang G, Zhu X, Qian Z. Therapeutic effects of volar anatomical plates versus locking plates for volar Barton’s fractures. Orthopedics 2012;35:e1198-203.  Back to cited text no. 17
    
18.
Agarwal AK, Nagi ON. Open reduction and internal fixation of volar Barton’s fracture—A prospective study. J Orthop Surg 2004;12:230-4.  Back to cited text no. 18
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1]



 

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