Analysis of the Variables Affecting Outcome in Fractures of the Distal Radius Treated by Open Reduction and Volar Locking Plate

Abstract

BACKGROUND: Some variables that could be related to results in fractures of the distal radius treated by open reduction and internal fixation (ORIF) with volar locking plates are still controversial.

PURPOSE: The purpose of this study was to find a possible correlation between various parameters, either patient-related (age, bone quality) or fracture-related (type, reduction), and to analyze the impact of these factors on the radiological and clinical outcome of distal radius fractures treated by volar locking plate.

METHODS: We included a total of 142 patients (145 fractures). Mean age 56 years (range, 19–87). The primary outcome measures were the following: Radiological (radial inclination, ulnar variance and palmar tilt at 3 and 6 months), clinical (the total Mayo wrist score) and the single score of each domain (pain, function, mobility and grip strength).

RESULTS: At follow-up, in 79 examined wrists (54.4%) there was no pain, in 55 wrists (37.9%) the pain was mild and in 11 (7.5%) cases the pain was moderate. Wrist function was good, and 83 (58.4%) patients returned to their normal activities; in 55 (38.7%) patients, function was slightly impaired, and function in 1 patient was mildly impaired. Unsatisfactory reduction occurred in 21 (14.4%) wrists, including one case of bilateral fracture.

CONCLUSIONS: We found no correlation between the patient’s sex or the time between the fracture and surgery and each of the parameters considered. A correlation was found between the type of fracture and three other parameters: the ulnar variance at 3 months, the range of motion and the total score (measured by the Mayo Wrist score). There was a statistically significant difference between type C2 and C3 concerning the ulnar variance at the 3-month follow-up. There was also a difference between type C1 and C3 concerning the range of motion and the total score, with a better outcome in the patients with a type C1 fracture.

Level of evidence: IV (case series).