Published online Oct 18, 2018. doi: 10.5312/wjo.v9.i10.203
Peer-review started: April 30, 2018
First decision: May 16, 2018
Revised: June 28, 2018
Accepted: August 20, 2018
Article in press: August 21, 2018
Published online: October 18, 2018
Treatment of distal radius fractures with volar locking distal radius plates (VLDRP) has become the most popular treatment method in the last ten years. Biomechanical and clinical studies indicate that distal screw placement as close as possible to the articular surface is crucial to prevent loss of postoperative reduction. To our knowledge, no study has been undertaken that proves or disproves this observation.
Our hypothesis was that postoperative loss of reduction will occur when the distal VLDRP screws are placed more proximal, in the distal radius fragment metaphysis, rather than in the subchondral hard area close to the articular surface. We also hypothesized that the loss of postoperative reduction is directly related to the distance of the distal screws from the articular surface. We undertook a retrospective study analyzing pre- and postoperative X-rays of 250 consecutive distal radius fractures treated with VLDRP.
Objectives of the study were to determine factors correlated with postoperative radial shortening in patients with distal radius fractures treated with VLDRPs.
This is a longitudinal multicentre retrospective cohort study including patients who underwent VLDRP fixation of a dorsally displaced distal radius fracture in which 250 wrist fractures were included. Collected parameters were fracture classification, radial length, radial inclination, volar inclination of the joint surface, patient age, gender, mechanism of injury, likelihood of osteoporosis, comorbidities and postoperative immobilisation. The distance of the distal locking screws to the articular surface was measured on intraoperative lateral tilted X-rays. Radial shortening as a parameter of loss of reduction was measured on X-rays obtained at a minimum of six weeks postoperatively. Bivariate statistical comparisons were used to identify factors influencing postoperative radial shortening. Multiple linear regression analysis then identified independent factors associated with postoperative radial shortening.
Multiple linear regression analysis showed that the distance of the distal locking screws from the articular surface was the only independent factor associated with radial shortening. The relationship between shortening and distance of the distal screws to the articular surface was linear and statistically highly significant.
Our study showed that in order to prevent postoperative loss of reduction in fractures plated with VLDRP, it is crucial that the distal screws are placed as close as possible to the articular surface. The study further indicated that loss of postoperative reduction is not associated with any other parameters measured - age, gender, osteoporosis, ASA status, fracture severity, immobilisation, number of distal screws and the presence or absence of a second distal screw row.
A major advantage of treating distal radius fractures with VLDRP is that patients can be treated without postoperative immobilisation. VLDRP are in fact the only treatment modality that allows for immediate postoperative use of the wrist. Based on the findings of our study and provided that the distal screws are placed as close as possible to the articular surface, immediate postoperative mobilization should be possible without loss of reduction. Future studies should attempt to verify our findings in a clinical setting.