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Jorge L. Orbay, MD, Miami , FL
Background
Articular fractures of the distal radius are more difficult to treat and lead to a worse prognosis. These fracture patterns although amenable to internal fixation have been managed with external fixation or combination of limited open reduction, Kirschner wire fixation and bone grafting. More recently open reduction and fragment specific fixation using multiple implants and two or more incisions has been advocated. Our intent is to show that these fractures can be successfully treated with a fixed angle device applied through a single volar incision.
Methods
We reviewed retrospectively 51 patients treated for intra-articular distal radius fractures at our centers between January 2000 and March 2002 using a fixed angle volar plate. Fractures were classified according to the "Comprehensive Classification of Long Bone Fractures". The average age was 48.3 years old (range 18-73 years old). At final follow-up, standard radiographic fracture parameters were measured, final functional results were assessed by measuring digital motion, wrist motion and grip strength and the Disabilities of the Arm, Shoulder and Hand (DASH) score system was applied.
Results
Of 51 patients fitting the inclusion criteria, we followed 48 patients with 50 intra-articular distal radius fractures for an average of 14.5 months (range 13-20 months). Three patients were lost to followup-up. The overall final outcome regarding patient satisfaction, residual pain and activity levels were highly satisfactory. Radiographic assessment at final follow-up showed an average volar tilt of 6 o , a radial tilt of 20 o , articular displacement of 1 mm and radial shortening of 1 mm. Wrist extension averaged 54 o , volar flexion 52 o , pronation 77 o and supination 72 o . Average grip strength accounted for 83% of the contralateral side.
Conclusions
Disregarding the direction and amount of initial displacement, articular fractures of the distal radius can be anatomically reduced through a volar approach. The use of a fixed angle volar plate provides adequate fixation to allow early motion and in this series has produced satisfactory functional results.
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