The use of a single volar locking plate for AO C3-type distal radius fractures

Abstract

Background: A single volar locking plate (VLP) is now frequently used for open reduction and internal fixation (ORIF) of many types of distal radius fractures. Comminuted intra-articular distal radius fractures (AO C3-type) are typically the most challenging to surgically treat. No studies directly address the adequacy of a VLP alone for maintaining reduction of AO C-type fractures. We hypothesized that a single VLP provides an effective method for maintaining reduction for these fractures.

Methods: We retrospectively evaluated radiographs of a series of AO C-type fractures. Seventy-seven patients with 77 AO C3-type fractures were identified from billing records and were eligible for the study. All patients were treated by fellowship-trained hand surgeons. Radiographs at the time of union were compared to those from immediately postoperatively.

Results: Sixty-nine of 77 (89.6 %) fractures treated with VLP fixation alone for AO C3-type distal radius fractures united without loss of reduction. Eight of 77 (10.4 %) patients treated with VLP for AO C3 fractures lost reduction. The most common fracture fragment to lose reduction was the lunate fossa (5 of 8); loss of reduction of the scaphoid fossa die-punch fragment (2 of 8) and the radial styloid (1 of 8) were also seen.

Conclusions: The majority (89.6 %) of AO C3-type fractures treated with a single volar locking plate come to union without loss of reduction.

Level of evidence: Level IV.

Keywords: Distal radius fracture; Volar locking plate.

Fig. 1

Final PA intraoperative flouroscopic image. The plate position is radial, and there is limited fixation of the lunate fossa fragment

Fig. 2

PA radiograph at union (5 months post-fixation) showing settling of the lunate facet fragment

Fig. 3

Final PA intraoperative fluoroscopic image post-fixation of a patient who subsequently lost fixation

Fig. 4

PA radiograph at union (7 months post-fixation) showing loss of fixation