Functional Outcome and Complications at 2.5 Years Following Volar Locking Plate Fixation of Distal Radius Fractures

Abstract

Distal radius fractures are increasingly treated by internal fixation, but there have been relatively few studies relating to functional outcome at 12 months or more. The aim of this study was to ascertain the patient reported function of the wrist at a minimum of 12 months following fixation of a distal radius fracture, the time taken to return to work, and the complication rate. We conducted a retrospective review of 187 consecutive patients treated by a specialist hand and wrist trauma team at a tertiary referral unit over a 5 year period. Mean age was 57.3 years (range 16-93). Median time to surgery was 4 days (interquartile range 2-9). Median follow up was 31 months (interquartile range 23-41 months). The median PRWE score was 3; (range 0-83). There was no difference in outcome in patients who had surgery delayed by greater than 2 weeks (p > 0.05). The median time to return to work was 5 weeks (interquartile range 1-8 weeks). There were 15 complications (8 %) including 3 tendon injuries. We have demonstrated an early return to work in patients who were employed, a low complication rate, and highly favourable functional outcomes at a mean of 30 months postoperatively. We recommend the use of the DVR plate and involvement of a dedicated hand and wrist trauma team for treatment of unstable fractures of the distal radius.

Keywords: Distal radius fracture; Locking plate; Outcome measure; PRWE.

Fig. 1

The Distal Volar Radius (DVR) plate

Fig. 2

a The FCR approach using a longitudinal incision over the FCR tendon. b FCR tendon is retracted ulnarward and the deep fascia is divided. c The flexor compartment musculature is bluntly swept ulnarward. d The pronator quadratus is then incised in an L shape along the watershed line to reveal the metaphyseal fragments. e An approprately sized plate is selected and its size and position checked fluoroscopically. f Metaphyseal fixation is achieved initially and the plate used to lever the distal fragment down to restore volar tilt

Fig. 3

a metaphyseal fixation prior to restoration of tilt. b The plate is used to lever the metaphysis volarwards to restore articular tilt

Fig. 4

Patient related wrist evaluation scores postoperatively (mean follow up time 31.8 months)