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14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

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Analysis of Carpal Malalignment in Distal Radius Fractures Following Volar Locking Plate Fixation

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  • presenting/speaker Kentaro Watanabe - Department of Orthopaedic Surgery, Nagoya Ekisaikai Hospital, Nagoya, Japan

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-254

doi: 10.3205/19ifssh0336, urn:nbn:de:0183-19ifssh03364

Published: February 6, 2020

© 2020 Watanabe.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Purpose: To clarify whether postoperative carpal alignment recovered anatomically after open reduction and internal fixation with a volar locking plate for the treatment of distal radius fractures, the change in carpal alignment, more specially dorsal displacement of the capitate, was evaluated.

Methods: Sixty-three patients (mean age, 59 years) underwent volar locking plate fixation with a single type of plate (DVR plate; Zimmer Biomet) within 1 week after injury. The fracture type according to the AO/OTA classification was A3 in 16 patients, C1 in four, C2 in 29, and C3 in 14. Radio-capitate distance (RCD), defined as the relative position of the capitate to the radius, was measured in addition to volar tilt (VT), radio-lunate angle (RLA), radial inclination (RI), volar prominence height (VPH), and volar cortical angle (VCA) using standardized radiographs of the uninjured and postoperative wrists. Each variable was compared statistically.

Results: Mean values of the variables for the uninjured wrists were, respectively, 1.4 mm for RCD, 8.5° for VT, 6.9° for RLA, 29.3° for RI, 9.9 mm VPH, and 50.0° for VCA. RCD for the uninjured wrists was not correlated with age and sex or laterality. RCD was moderately related to VPH, RLA, and VT, weakly related to VCA, and not related to RI. Mean values of the variables for the postoperative wrists were, respectively, -1.2 mm for RCD, 4.8° for VT, 1.6° for RLA, 27.2° for RI, 9.2 mm for VPH, and 34.7° for VCA. Each variable decreased significantly, which indicated a persistent dorsal shift of the distal carpal row. The change in RCD was strongly related to that in VPH, moderately related to that in VCA and RLA, weakly related to that in VT, and not related to that in RI.

Conclusions: Anatomical recovery of carpal alignment was not routinely achieved with the use of a single type of plate. RCD should be further evaluated as a parameter for use in distal radius fracture treatment because of its comprehensive association with the parameters such as VPH, VCA, and VT which indicate displacement of the distal fragment.