prospective study on comminuted distal radius fracture fixed with fixed angle volar plate

1. A prospective study
on functional outcome of volar plating
distal end radius.
presenter: Dr. Raghvendra Singh R.
PG dept. orthopaedics.

2. 1. Fracture distal radius is the most
common fracture treated;
10 to 25%;1/6.
2. The goal of the treatment for fracture
distal radius should be to restore
function of the affected wrist at the
best, to limit pain and to reach full
functional ability .

3.  In case of intra-articular fractures anatomical
reconstruction is of utmost importance to obtain
good functional results. An
intra-articular step of more than 2 mm inevitably
leads to osteoarthritis and functional deficit.
 Conservative treatment often leads to radial
shortening which leads to poor functional
outcome.

4.  volar plate fixation is a valuable method because of the
decreased risk of inducing dorsal soft-tissue
complications.
 Because there is more space between the volar cortex
and the flexor tendons in the volar approach, the volar
anatomy of the wrist presents an advantage over the
dorsal aspect.

5. The volar surface of the distal radius is
relatively flat and covered proximally by the
pronator quadratus muscle.

6. To evaluate the functional outcome of volar
fixed angle plate fixation for distal radius
fractures and to assess its benefits in
terms of amount of pain, finger motion ,
wrist motion , grip strength ,DASH score,
Modified Green and Obrien score ,
deformity and ranges of motions in
affected wrist after surgery.

7. .
Classification. AO

8. Place of study : Department of
Orthopaedic Surgery, Regional Institute of
Medical Sciences (RIMS), Imphal, Manipur
Duration : from September 2011 to August
2013.
Type of study : prospective .
 Follow up : for a period of 12 months.

9. Inclusion criteria:
1.Fractures of the distal end of radius.
2.Age between 20 to 70 years .
Exclusion criteria:
1. Patients with mental and physical
inability to co-operate.
2. Distal radius fracture extending to
shaft of radius .
3. Concomitant fracture in the same limb.

10.  The fractures will be assessed by antero-
posterior and lateral view X-rays.
 All routine Investigations .
PRE-OPERATIVE PREPARATION
 A closed reduction will be performed, both to
assess fracture fragment stability and to
make open reduction easier.

11. Positioning
supine position with hand supported on hand
table. Tourniquet was applied for every case .
Anesthesia.
every case taken under general anesthesia.
Skin incision
An incision is made using the flexor carpi
radialis (FCR) approach, over the volar aspect;with
distal extension as necessary. The skin incision
should be centered over the FCR tendon and of
approximately 10 cm length.

12.  Internal fixation
The fracture line and distal fragments will be exposed. The
distal fragment positions adjusted and appropriate volar
plate will be positioned to assess its optimum fitting.
Optimal length screws will be selected and fixed. It is
important that any discontinuity in the articular surface of
the distal radius be minimised and the drill holes/screws
chosen with their length appropriate to the location to avoid
dorsal screw penetration through the far cortex and extensor
tensor tendon rupture .
After Closure of the skin, a final check will be performed for
plate prominence and distal radio ulnar joint instability

13. subjective and objective parametres
Radiological parametres
 Modified Green and Obrien score
DASH score

14. 0
2
4
6
8
10
12
20 -30 30 -40 40 -50 50-60 60-70
male 11
female 19
total 30

15. female 63.3%
male 36.67%

16. 0
5
10
15
20
25
dominant non dominant

17. 0
2
4
6
8
10
12
14
A extra articular B partial articular C intra articular

18. At 6wk ,3 month,6 month , 1 year
significant improvement over time in pain,
grip strength, restricted activities and
patients satisfaction.

19. parameter Preoperative Postoperative 1 year
Volar tilt in
degree
–9.3 ± 18.8
Range -40 to 28
degree
10.1 ± 5.8
Range 0 to 25
degree
9.7 ± 5.0
Range 3 to 23
degree
Radial
inclination in
degree
14.1 ± 4.9
Range 7 to 25
degree
19.3 ± 4.2
Range 12 to 28
degree
20.0 ± 4.2
Range 12 to 28
degree
Ulnar variance
in mm
4.3 ± 2.3
Range 1 to 8.7
mm
–0.5 ± 1.4
Range -2 to 2.9
mm
0.2 ± 0.9
range -1.7 to 2.4
mm

20. Wrist extension
(degrees)
Wrist flexion
(degrees)
Forearm
pronation
(degrees)
Forearm
supination
(degrees)
55.5 ± 10.3 59.3 ± 17.5 86.3 ± 17.2 90.4 ± 5.9
range
45 to 80 degree
range
50 to 90 degree
range
Range 30 to 100
range
Range 30 to 100

21. 0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Excellent Good Fair Poor

22. DASH score
changed from pre-injury baseline of 2
to 7 ;
at the end of 1 year indicating high
degree of patient satisfaction.
 Final average Modified Green and
O`Briens system
at one year review scores 92 % showing
excellent result.

23. Overall 3 patients showed complications
,
two developed tenosynovitis , one
developed partial finger contracture.
 no non union or implant failure noted in
this study.
Tenosynovitis is a risk factor for
progressive damage to tendons so
included as a complication.

24.  Distal radius plate is useful for achieving good
anatomical reduction, but care must be taken to
avoid the complication of tendon rupture. Placing
the plate proximally to the watershed line and
removing the plate as soon as the fracture united
were necessary to avoid the complication of
tendon rupture.
 Internal fixation of distal radius fractures with
implants featuring locking screw fixation can
result in good to excellent outcomes with
limited number of complications .

25. .