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Outcome of AO Type C Fractures Distal Radius treated with Volar Locking Plates in a Tertiary care center Lahore
Keywords:
AO Type C fracture, Distal Radius, Internal Fixation, Locking plate, Radial Height, Radial Inclination, Volar Tilt.Abstract
Objective: To determine the clinical and radiological outcome of AO Type C fracture distal radius treated with 2.4mm Titanium volar locking plates.
Methods: This descriptive study was conducted in Department of Hand and Upper limb Surgery(HULS) Combined Military Hospital(CMH) Lahore Pakistan from 23rd January 2016 to 4th January 2019.All adults patients of either gender with distal radius fractures(Type C) fulfilling the inclusion criteria were treated with 2.4mm volar locking plates. Post operative flexion and extension of the wrist was measured with goniometer and grip strength with a weighing scale. Radiological outcome was determined by comparing pre operative and post operative radial height, radial inclination and volar tilt. P value was calculated for net improvement of radiological outcome and < 0.05 was considered significant.
Results: The total number of patients in our study were 52.Mean age of the patients were 40.26 ± 12.7 years(range 18 to 69 years).Male patients were 39(75%) and female 13(25%).Right radius was fractured in 28(53.8%) patients and left in 24(46.1%).AO type C2 fracture was noted in 24(46.1%),C1 in 19(36.5%) and C3 in 9(17.3%) patients. Post operative mean wrist flexion was 78°±7 (range 62° to 80°) and extension 68°±4 (range 60° to 75°)at last follow up. The grip strength was excellent in 22(42.3%), good in 18(34.6%) and average in 12(23%).The mean value of pre operative Radial Height(RH) was improved from5.35±3.32 to 11.42±0.800, Radial Inclination(RI) from 13.83±3.71 to 21.09±0.793 degrees, and Volar Tilt(VT) from 5.43±11.9 to11.22±0.951 degrees. The net improvement in RH, RI and VT was 6.11 ± 2.77, 7.26 ± 2.89 and 15.65 ± 14.26 (P > 0.05).No major complication was documented in our study.
Conclusion: Titanium volar locking plates produced excellent functional and radiological outcome in patients with intra articular fractures of the distal radius. We therefore, recommend 2.4mm Titanium volar locking plate as implant of choice to treat Type C fractures.
References
Wigg AE, Hearn TC, McCaul KA, Anderton SM, Wells VM, Jeganath K. Projections of distal forearm fractures admitted to hospital in Australia. J Trauma.2003;55: 87-93.
Handoll HH, Huntley JS, Madhok R.External fixation versus conservative treatment for distal radial fractures in adults. J Bone joint Surg Am.2007; 90:451-454.
McQueen MM, Hajducka C, Court-Brown CM.Re-displaced unstable fractures of the distal radius: a prospective randomized comparison of four methods of treatment. J Bone Joint Surg Br.1996;78:404-409.
Chen NC, Jupiter JB. Management of distal radial fractures. J Bone Joint Surg Am.2007;89:2051-2062.
Vasenius J. Operative treatment of distal radius fractures. Scand J Surg.2008; 97:290-296.
Henry MH. Distal radius fractures: Current concepts. J Hand Surg Am.2008;33:1215-1227.
Martineau PA, Berry GK, Harvey EJ.Plating for distal radius fractures. Hand Clin.2010; 26:61-69.
Benson LS, Minihane KP, Stern LD, Eller E, Seshadri R. The outcome of intra-articular distal radius fractures treated with fragment-specific fixation. J Hand Surg Am.2006; 31:1333-1339.
Mackenney PJ, McQueen MM, Elton R.Prediction of instability in distal radial fractures. J Bone Joint Surg Am.2006; 88:1944-1951.
Finsen V, Rod O, Rod K, Rajabi B, lm-Paulsen PS, Russwurm H. The relationship between displacement and clinical outcome after distal radius (Colles’) fracture. J Hand Surg Eur.2012; 21-28.
Handoll HH, Madhok R.Surgical interventions for treating distal radial fractures in adults. Cochrane Database Syst Rev3.2003;CD003209.
Handoll HH, Madhok R, Howe TE. Rehabilitation for distal radial fractures in adults. Cochrane Database Syst Rev 3.2006;CD003324.
Egol KA, Walsh M, Romo-Cardoso S, Dorsky S, Paksima N.Distal radial fractures in the elderly: operative compared with nonoperative treatment. J Bone Joint Surg Am.2010; 92:1851-1857.
Orbay JL. The treatment of unstable distal radius fractures with volar fixation. Hand Surg.2000; 5:103-112.
Protopsaltis TS, Ruch DS.Volar approach to distal radius fractures. J Hand Surg Am.2008; 33:958-965.
Downing ND, Karantana A.A revolution in the management of fractures of the distal radius? J Bone Joint Surg Br.2008; 90:1271-1275.
Yoon A, Grewal R. Management of distal radius fractures from the North American perspective. Hand Clin.2012; 28:135-144.
Kreder HJ, Hanel PD, McKee M, Jupiter J, McGillivary G, Swiontkowski MF. X-ray film measurements for healed distal radius fractures. J Hand Surg Am. 1996;21(1):31-39.
Reynolds SH. Climbing Your Best: Training to Maximize Your Performance. Mechanicsburg, PA: Stackpole Books. 2001; Pp. 9.
Heyward VH. Advanced Fitness Assessment & Exercise Prescription. Champaign, IL: Human Kinetics. 2010; Pp. 133.
Jupiter JB, Marent-Huber M.Operative management of distal radial fractures with 2.4-millimeter locking plates. A multicenter prospective case series. J Bone Joint Surg Am.2009; 91:55-65.
Hull P, Baraza N, Gohil M, Whalley H, Mauffrey C, Brewster M, et al. Volar locking plates versus k-wire fixation of dorsally displaced distal radius fractures-a functional outcome study. J Trauma.2001;70(6):125-128.
Dicpinigaitis P, Wolinsky P, Hiebert R, Egol K, Koval K, Tejwani N.Can external fixation maintain reduction after distal radius fractures? J Trauma.2004;57:845-850.
Peine R, Rikli DA, Hoffmann R, Duda G, Regazzoni P.Comparison of three different plating techniques for the dorsum of the distal radius: a biomechanical study. J Hand Surg Am.2000; 25:29-33.
Rikli DA, Regazzoni P.The double plating technique for distal radius fractures. Tech Hand Up Extrem Surg.2000; 4:107-114.
Chou YC, Chen AC, Chen CY, Hsu YH, Wu CC .Dorsal and volar 2.4-mm titanium locking plate fixation for AO type C3 dorsally comminuted distal radius fractures. J Hand Surg Am.2011; 36:974-981.
Gereli A, Nalbantoglu U, Kocaoglu B, Turkmen M. Comparison of palmar locking plate and K-wire augmented external fixation for intra-articular and comminuted distal radius fractures. Acta Orthop Traumatol Turc.2010; 44(3):212-219.
Khamaisy S, Weil YA, Safran O, Liebergall M, Mosheiff R, Khoury A.Outcome of dorsally comminuted versus intact distal radial fracture fixed with volar locking plates. Injury.2011; 42(4):393-396.
MS, Noordinn S, Hashmi PM. Intra-articular distal radius fractures: Postoperative roentgenographic and functional outcomes. J Pak Med Assoc.2016;66(3):275-9.
Osada D, Kamei S, Masuzaki K, Takai M, Kameda M, Tamai K. Prospective study of distal radius fractures treated With a volar locking plate system. J Hand Surg.2008;33(5):691-700.
Earp BE, Foster B, Blazar PE. The Use of a Single Volar Locking Plate for AO C3-Type Distal Radius Fractures.Hand.2015;10:649-653.
Gruber G, Gruber K, Giessauf C, Clar H, Zacherl M, Fuerst F, Alexander, Bernhardt A. Volar Plate Fixation of AO Type C2 and C3 Distal Radius Fractures, A Single-Center Study of 55 Patients. Journal of Orthopaedic Trauma.2008;22(7):467-472.
Fowler JR, Ilyas AM. Prospective Evaluation of Distal Radius Fractures Treated With Variable-Angle Volar Locking Plates. J Hand Surg. 2013;38(11):2198-2203.
Rein S, Schikore H, Schneiders W, Amlang M, Zwipp H. Results of Dorsal or Volar Plate Fixation of AO Type C3 Distal Radius Fractures: A Retrospective Study. J Hand Surg.2007;32(7):954-961.
Li Y, Zhou Y, Zhang X, Tian D, Zhang B. Incidence of complications and secondary procedure following distal radius fractures treated by volar locking plate (VLP). J Orthop Surg Res.2019; 295:41-52.
