The Journal of Bone and Joint Surgery (American). 2006;88:2687-2694.
doi:10.2106/JBJS.E.01298
© 2006 The Journal of Bone and Joint Surgery, Inc.
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Treatment of Unstable Distal Radial Fractures with the Volar Locking Plating System

Kevin C. Chung, MD, MS1, Andrew J. Watt, MD1, Sandra V. Kotsis, MPH1, Zvi Margaliot, MD, MS1, Steven C. Haase, MD1 and H. Myra Kim, ScD2

1 Section of Plastic Surgery, Department of Surgery, University of Michigan Health System, 2130 Taubman Center, 1500 E. Medical Center Drive, Ann Arbor, MI 48109-0340. E-mail address for K.C. Chung: kecchung{at}med.umich.edu
2 Center for Statistical Consultation and Research, University of Michigan, 3550 Rackham Building, 915 E. Washington Street, Ann Arbor, MI 48109-1070

Investigation performed at the Section of Plastic Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan

A video supplement to this article will be available from the Video Journal of Orthopaedics. A video clip will be available at the JBJS web site, www.jbjs.org. The Video Journal of Orthopaedics can be contacted at (805) 962-3410, web site: www.vjortho.com.

In support of their research for or preparation of this manuscript, one or more of the authors received grants or outside funding from the American Association for Hand Surgery and the Department of Surgery, University of Michigan Health System. None of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: The best treatment for an inadequately reduced fracture of the distal part of the radius is not well established. We collected prospective outcomes data for patients undergoing open reduction and internal fixation of an inadequately reduced distal radial fracture with use of the volar locking plating system.

Methods: Over a two-year period, 161 patients underwent open reduction and internal fixation of an inadequately reduced distal radial fracture with use of the volar locking plating system. Patients were enrolled in the present study three months after the fracture on the basis of strict entry criteria and were evaluated three, six, and twelve months after surgery. Outcome measures included radiographic parameters, grip strength, lateral pinch strength, the Jebsen-Taylor test, wrist range of motion, and the Michigan Hand Outcomes Questionnaire.

Results: Eighty-seven patients with a distal radial fracture were enrolled. The mean age at the time of enrollment was 48.9 years. Forty percent (thirty-five) of the eighty-seven fractures were classified as AO type A, 9% (eight) were classified as type B, and 51% (forty-four) were classified as type C. Radiographic assessment showed that the plating system maintained anatomic reduction at the follow-up periods. At the time of the twelve-month follow-up, the mean grip strength on the injured side was worse than that on the contralateral side (18 compared with 21 kg; p < 0.01), the mean pinch strength on the injured side was not significantly different from that on the contralateral side (8.7 compared with 8.9 kg; p = 0.27), and the mean flexion of the wrist on the injured side was 86% of that on the contralateral side. All Michigan Hand Outcomes Questionnaire domains approached normal scores at six months, with small continued improvement to one year.

Conclusions: The volar locking plating system appears to provide effective fixation when used for the treatment of initially inadequately reduced distal radial fractures.

Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.


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Letters to the Editor:

Read all Letters to the Editor

Volar locking plate: Can it be used for all unstable distal radius fractures?
Bhavuk Garg, et al.
JBJS Online, 9 Jan 2007 [Full text]
Dr. Chung et al. respond to Dr. Garg et al.
Kevin C Chung, M.D., MS, et al.
JBJS Online, 23 Jan 2007 [Full text]
Treatment of Unstable Distal Radius Fractures with the Volar Locking Plating System
Gregory L. DeSilva, M.D.
JBJS Online, 21 Feb 2007 [Full text]
Dr. Chung et al. respond to Dr. DeSilva
Kevin C. Chung, M.D., et al.
JBJS Online, 21 Feb 2007 [Full text]