A prospective study on short term analysis of clinical, radiological and functional outcome of surgical management of Type B & Type C distal radius fracture with volar locking plate

INTRODUCTION: Distal Radius fracture have a Bimodal age distribution, among these one with younger age group who sustained injury due to highenergy trauma and another group of elderly patients with relatively low energy trauma. Due to its high energy association, now most of the distal radius fractures are associated with other long bone fractures. So much of importance is given in treating long bone fracture fixation, and neglecting distal radius fracture which results in poor functional outcome. Good functional results were reported with either modality in low energy fractures in elderly but the ideal treatment for high energy injuries with comminuted distal radius fractures is still being debated. This justifies a separate review on internal fixation of distal radius fractures. AIM: To analyse the “Short Term Analysis of Clinical, Radiological & Functional Outcome of Surgical Management of Type B & Type C Distal Radius Fracture with Volar Locking Plate” done in our Institute of Orthopaedics and Traumatology, Madras medical College and Rajiv Gandhi Government General Hospital between the period of May 2011 and November 2013. MATERIALS AND METHODS: This study was designed to review the Short Term analysis of clinical, Functional and Radiological outcomes of Surgical Management of Type B & Type c Distal Radius Fracture with Volar Locking Plate. From May 2011 to Nov 2013, 28 consecutive fractures of Intraarticular Distal radius in skeletally matured patients were managed primarily by internal fixation with Locking compression plate whose screws are multidirectional. The criteria for patient selection were as follows, Inclusion Criteria: 1. Age more than 18 years, 2. AO type B and type C Distal Radius intraarticular fracture associated with or without ulnar styloid fracture, 3. Closed type B & C Distal Radius fractures and 4. Intrarticular Distal Radius fracture with either volar or dorsal displacement. Exclusion Criteria: 1. All undisplaced Extraarticular Radial fracture, 2. All open fractures, 3. Severe osteoporosis with limited functional capacities, 4. Medical co-morbidities and 5. Age less than 18 years. Patients of both sexes were recruited in the study according to the devised inclusion and exclusion criteria. RESULTS: The follow up in mean was 6 months, range between 3 months & 18 months. 26 of the 28 patients had regular follow-up. Two patients are lost to follow-up after surgery due to social reasons. Hence only 26 patients were analyzed and the results are as follows, UNION: Good bony union is visualized radio logically in all our study patients. The mean time of union was 12 weeks with a range of 10 to 18 weeks, with 22 pts majority of 84% healed by 12 weeks. Rest of the 4 cases took a longer duration. One case of delayed union was reported. Longer duration to union is noted in patients of with severity of comminution and bone loss. MALUNION: Three were 3 instances of loss of reduction with fracture collapse, which resulted in intra-articular violation of screws. NON UNION : Two instances of nonunion of basistyloid ulnar fracture group was reported out of nine patients. The ulnar styloid component was not addressed in our study. CONCLUSION: From our study, we conclude that; • Early Primary fixation of the distal radius fractures is essential for good functional outcome and to avoid complication of prolonged immobilization, which facilitates early return to regular activities. • Patients with unstable, either volar or dorsally displaced fractures of distal radius had excellent or good fuctional outcome when treated with fixed angle volar locking plate. • With a stable DRUJ after fixation of distal Radius fractures by means of angle stable volar locking plate maintains DRUJ stability. The coexistence of ulnar styloid fracture in these patients did not affect in terms of functional outcome. • Patients with persistent DRUJ insatiability were stabilized with radioulnar transfixation wire for a period of 4 weeks. Then it was removed and vigorous wrist mobilization resulted in good functional outcome. • However long term follow-up is needed to further validate our findings