A comparative study of fragment-specific versus volar plate fixation of distal radius fractures

Abstract

Background: There are many plating systems available for treating distal radius fractures, and deciding which to use can be difficult. This prospective cohort study compared outcomes of two commonly used fixation systems: fragment-specific fixation and a fixed-angle volar locking plate system.

Methods: Consecutive distal radius fractures were prospectively evaluated in a fragment-specific fixation cohort and a volar locking plate system cohort. Radiographic, functional, and patient-rated outcomes were collected immediately postoperatively and at 6 and 12 months postoperatively. Complications were recorded and graded by severity.

Results: Fourteen distal radius fractures treated with fragment-specific fixation and 85 treated with the volar locking plate system were enrolled. Radial inclination was similar in both cohorts (23 degrees versus 25 degrees); however, volar tilt was worse in the fragment-specific fixation cohort (-10 degrees versus 10 degrees, p < 0.05). The majority (63 percent) of the fragment-specific fixation cohort demonstrated a loss of relative radial length. Grip strength, pinch strength, Michigan Hand Outcomes Questionnaire scores, and most range of motion measurements were superior in the volar locking plate system cohort at 6 months, although not all differences were statistically significant. By 12 months the differences in functional and patient-rated outcomes were smaller, suggesting that the fragment-specific fixation cohort tended to reach the outcomes of the volar locking plate system cohort over time. Complications requiring reoperation were higher in the fragment-specific fixation cohort (p < 0.05).

Conclusions: The volar locking plate system results in more stable fixation and better objective and subjective outcomes early in the postoperative period. It has fewer complications requiring reoperation than fragment-specific fixation.

Figure 1

Radial and ulnar pin plates augmented with K-wires and proximal screws for fixation of radial and ulnar column fractures.

Figure 2

Pre-operative views above show the fracture through the neck of the ulna and the ulnar translation of the distal radius fragment. Post-operative views below show contour plate fixation of the ulnar fracture, and 90-90 degree angle fixation of radial and ulnar columns of the distal radius.

Figure 3

The sequential placement of the wire-form to support a depressed articular distal radius fracture.

Figure 4

Figure 4 A & B. Pre-operative above show a comminuted and dorsally angulated intra-articular distal radius fracture. Figure 4C & D. Post-operative views demonstrate anatomic reduction and fixation with the VLPS. The lateral view may suggest entrance of the distal pegs into the radial carpal joint, but a 30-degree lateral view aligning with the x-ray beam will better demonstrate the subchondral placement of the pegs.

Figure 4

Figure 4 A & B. Pre-operative above show a comminuted and dorsally angulated intra-articular distal radius fracture. Figure 4C & D. Post-operative views demonstrate anatomic reduction and fixation with the VLPS. The lateral view may suggest entrance of the distal pegs into the radial carpal joint, but a 30-degree lateral view aligning with the x-ray beam will better demonstrate the subchondral placement of the pegs.

Figure 4

Figure 4 A & B. Pre-operative above show a comminuted and dorsally angulated intra-articular distal radius fracture. Figure 4C & D. Post-operative views demonstrate anatomic reduction and fixation with the VLPS. The lateral view may suggest entrance of the distal pegs into the radial carpal joint, but a 30-degree lateral view aligning with the x-ray beam will better demonstrate the subchondral placement of the pegs.

Figure 4

Figure 4 A & B. Pre-operative above show a comminuted and dorsally angulated intra-articular distal radius fracture. Figure 4C & D. Post-operative views demonstrate anatomic reduction and fixation with the VLPS. The lateral view may suggest entrance of the distal pegs into the radial carpal joint, but a 30-degree lateral view aligning with the x-ray beam will better demonstrate the subchondral placement of the pegs.