gms | German Medical Science

Objectives/Interrogation: To evaluate the long-term outcomes of treatment with volar locking plate (VLP) for the intra-articular distal radius fractures with clinical and radiological evaluation at least more than 5 years after surgery.

Methods: Twenty limbs (9 males and 11 women) of 44 distal radius intra-articular fractures that were treated surgically with VLP during the 5-year period from 2006 to 2010 were directly examined. Subjects included 1 limb of B3, 5 limbs of C1, 10 limbs of C2, and 4 limbs of C3 in AO classification. The mean age at surgery was 65.8 years (range, 48-81 years) and the mean postoperative follow-up period was 7.4 years (range, 5.1-9.8 years). X-ray parameters (RI; radial inclination, VT; volar tilt, UV; ulnar variance) at immediate post-operation and final follow-up, the articular gap and step-off on immediate postoperative X-ray, and osteoarthritic changes on final plain X-ray (evaluated by Knirk and Jupiter classification; KJ), Quick-DASH score, VAS score (full score of 10), range of motion, and grip strength were evaluated.

Results and Conclusions: Although there were no significant changes in RI and VT, the UV significantly increased from 0 mm at immediate postoperative X-ray to 0.7 mm at the final follow-up X-ray (p = 0.02). There were 4 limbs without joint space narrowing (KJ 0), 10 limbs with mild narrowing (KJ 1), 4 limbs with obvious narrowing (KJ 2), and 2 limbs with osteophytes and cyst formation (KJ 3). The articular gap and step-off on immediate postoperative X-ray averaged 1.1 mm. For the correlation between the articular gap and step-off and KJ classification, and between AO classification and KJ classification, greater residual articular gap and step-off and more complex fracture type significantly progressed osteoarthritic change (p < 0.01 and p = 0.02, respectively). Average Quick-DASH score was 3.3 points, and average VAS score was 0.55 points, indicating good self-assessment results. Quick-DASH score was not significantly correlated with KJ classification, however VAS score and KJ classification were significantly correlated (p = 0.03). The mean range of motion was almost the same as that on the unaffected side, and the mean ratio of grip strength on the affected side was 0.98, indicating good functional recovery.

We concluded that long-term outcomes of the distal radius fractures with VLP showed a significant correlation between fracture type or reduction status of the articular surface and osteoarthritic progression, however functional outcomes were good.