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Abstract
The aim of the work was to evaluate the radiological and functional results of using the volar locking plate in the management of distal radial fractures.
Thirty two patients were included in the study, at the time of calculating the statistical analysis and the results only 23 patients had fulfilled the follow up requirements and were included.
On admission, all patients were assessed by: history taking, clinical examination and appropriate radiological assessment.
The mean age was 44.74 years. The youngest patient in this study was 25 years old while the oldest was 74 years old. Fourteen patients were females (61%) and nine patients were males (39%). Thirteen patients had dominant side affection (56.5%), while ten patients had non-dominant side affection (43.5%).
The mechanism of trauma in the patients was falling on an outstretched hand in 11 patients (48%), falling from height in five patients (22%), road traffic accidents in five patients (22%) and a direct trauma in two patients (8%).
Facture type according to the AO classification was; Type A2: 4 (17.4%), Type A3: 7 (30.4%), Type B2: 2 (8.7%), Type C2: 2 (8.7%), Type C3: 8 (34.8%).
Locking plates do not depend on screw purchase and friction between the plate and bone for distal fragment support but rather on direct internal buttressing provided by the fixed-angle elements. This is of special value in comminuted fractures and osteoporotic bone.
Open reduction was performed using the volar flexor carpi radialis approach. The fracture was held temporarily by k-wires and then fixed a volarly placed T-locking plate. In some intra-articular fractures concomitant k-wires were used.
After the follow up period that ranged from six to seventeen months, the data gained from analysis of information obtained from the patients subjectively, objectively and radiologically were evaluated, processed and tabulated.
The results were assessed according to the Sarmiento’s modification of Gartland & Werley scoring system of the wrist and the following results were obtained; 12 patients (52.17 %) had excellent results (scores between 0 and 2), 9 patients (39.13 %) had good results (scores between 3 and 8) and 2 patients (8.7%) had fair results (scores between 9 -21), this corresponds to 91.3% of the patients had satisfactory results, while 8.7% of the patients had unsatisfactory results.
The nearer the radiological parameters of the fracture to the anatomical position at time of union the better the results. There was statistically significant correlation between the residual amount of radial shortening, the final radial inclination angle and the final clinical scores.
The final clinical results were not related to fracture type; where type (B2) fractures had the best outcome followed by type (A2) and type (C2), while type (C3) had the worst outcome, this difference was statistically insignificant.
There was a positive correlation between the duration of follow up period and the final score, the longer the duration of follow-up period the better the final outcome.
The associated (untreated) ulnar styloid fractures did not affect the final clinical score significantly.
There was a positive statistically significant correlation between the duration of immobilization and the final score. The longer the immobilization period after fracture fixation the less favorable the results.
The complications included: CRPS type I (one case), Carpal tunnel syndrome (two cases), intra-articular screw penetration (one case), plate bending (one case), loss of reduction (two cases) and non-union (one case).