gms | German Medical Science

Objectives/Interrogation: In volar locking plate (VLP) fixation for distal radius fracture, it is significant to put the distal screws next to subchondral bone, which minimizes the postoperative correction loss, which is related to the clinical outcome. We developed a method for effective subchondral support operation with using cannulated screws at distal screw holes of VLP and assessed the utility.

Methods: 39 cases of distal radial fracture in 39 patients were included in the study. Global Form (Nexmed, Chiba, Japan) was employed for internal fixation to treat distal radial fractures. The mean patient age was 62.1 years, and the mean follow-up period was 460.1 days. According to the AO classification, there were 13 patients with type A and 26 with type C. At all the distal screw holes, 0.8 mm guide wire was inserted along the subchondral bone with feeling the touch of bone and a 2.4 mm cannulated locking screw was set in the position. We evaluated postoperative clinical outcomes on postoperative corrective loss in radiographs, minimum distance between distal screws and the radial subchondral bone (MD [mm]) in CT images, the Modified Mayo Wrist Score (MWS), and DASH score. Statistical analysis was done with the unpaired two-tailed Student's t-test.

Results and Conclusions: The mean amounts of correction loss were VT-2.2°, RI-2.29°, and UV+0.85 mm, and the mean MD was 1.59 ± 1.60. Regarding MWS, the results were "excellent" in 24 patients, "good" in 10, "fair" in 5 and "poor" in 1. The mean DASH score was 7.7. The Pearson's coefficients of correlations between the mean MD and the amounts of correction loss with respect to VT, RI, and UV were 0.11, 0.08, and -0.35, respectively, and a weak correlation was observed with the UV. No statistically significant difference was found between MD and the clinical outcome (p = 0.45).

Our trial can be useful for effective subchondral support with screws to treat distal radius fractures.