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Archives of Orthopaedic and Trauma Surgery

Erschienen in:

27.03.2020 | Handsurgery

Functional and radiological outcome of distal radius fractures stabilized by volar-locking plate with a minimum follow-up of 1 year

verfasst von: Stefan Quadlbauer, Ch. Pezzei, J. Jurkowitsch, R. Rosenauer, A. Pichler, S. Schättin, T. Hausner, M. Leixnering

Erschienen in: Archives of Orthopaedic and Trauma Surgery | Ausgabe 6/2020

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Abstract

Introduction

Distal radius fractures (DRF) are the most common fractures of the upper extremities and incidence is expected to continue rising as life expectancy increases. Palmar locking plate stabilizing has since become the standard treatment for dorsally displaced DRF. Main aim of this study was to investigate correlation between radiological and clinical outcome in patients stabilized by palmar locking plate with a minimum follow-up of one year.

Methods

A total of 524 patients with DRF, stabilized using palmar angular stable locking plate fixation were included in the study. Of these, 117 patients had to be excluded and another 177 were not accessible. The study group thus compromised 230 patients who returned for the follow-up investigation and were followed-up clinically and radiologically with a mean follow-up interval of 20 months. Outcome was evaluated using pain, range of motion (ROM) and grip strength parameters. In addition, self-assessment by patients was registered on the QuickDASH, PRWE and Mayo Score. The immediate postoperative and final checkup radiographs were scrutinized for alignment and intra-articular step-off.

Results

Bivariant correlation analysis showed a significant correlation between ulnar variance and QuickDASH (r = 0.18, p = 0.01), grip strength (r = − 0.18, p = 0.04) and Mayo Score (r = − 0.23, p = 0.001). No significant differences could be found between an unacceptable (> 2 mm) and acceptable (< 2 mm) ulnar variance in respect of pain, ROM, grip strength and patient-reported outcome measurements. Age, gender, additional fracture to the ulnar styloid, or type of postoperative immobilization showed no significant or clinical important impact on the final patient-reported outcome. No significant differences in incidence of complications, ROM or loss of reduction could be found in any patients over or under 65 years of age.

Conclusions

Stabilization of DRF by palmar angular stable locking plate is a safe form of treatment and results in a good clinical and radiological outcome with low complication rate. Ulnar variance showed a significant correlation to grip strength, QuickDASH and Mayo Score, but an unacceptable ulnar variance (> 2 mm) was not associated with a worse clinical important outcome. Age (< 65/> 65 years), gender and type of immobilization had no impact on the complication rate or in the final functional or radiological outcome.

MacIntyre NJ, Dewan N (2016) Epidemiology of distal radius fractures and factors predicting risk and prognosis. J Hand Ther 29:136–145. https://doi.org/10.1016/j.jht.2016.03.003 CrossRefPubMed

Figl M, Weninger P, Liska M et al (2009) Volar fixed-angle plate osteosynthesis of unstable distal radius fractures: 12 months results. Arch Orthop Trauma Surg 129:661–669. https://doi.org/10.1007/s00402-009-0830-z CrossRefPubMed

Figl M, Weninger P, Jurkowitsch J et al (2010) Unstable distal radius fractures in the elderly patient-volar fixed-angle plate osteosynthesis prevents secondary loss of reduction. J Trauma Inj Infect Crit Care 68:992–998. https://doi.org/10.1097/TA.0b013e3181b99f71 CrossRef

Gologan RE, Koeck M, Suda AJ, Obertacke U (2019) %3e 10-year outcome of dislocated radial fractures with concomitant intracarpal lesions as proven by MRI and CT. Arch Orthop Trauma Surg 139:877–881. https://doi.org/10.1007/s00402-019-03186-8 CrossRefPubMed

Esenwein P, Sonderegger J, Gruenert J et al (2013) Complications following palmar plate fixation of distal radius fractures: a review of 665 cases. Arch Orthop Trauma Surg 133:1155–1162CrossRef

Le ZS, Kan SL, Su LX, Wang B (2015) Meta-analysis for dorsally displaced distal radius fracture fixation: volar locking plate versus percutaneous Kirschner wires. J Orthop Surg Res. https://doi.org/10.1186/s13018-015-0252-2 CrossRef

Wei DH, Raizman NM, Bottino CJ et al (2009) Unstable distal radial fractures treated with external fixation, a radial column plate, or a volar plate: prospective randomized trial. J Bone Jt Surg Ser A 91:1568–1577. https://doi.org/10.2106/JBJS.H.00722 CrossRef

Quadlbauer S, Pezzei C, Jurkowitsch J et al (2018) Early complications and radiological outcome after distal radius fractures stabilized by volar angular stable locking plate. Arch Orthop Trauma Surg 138:1773–1782. https://doi.org/10.1007/s00402-018-3051-5 CrossRefPubMed

Oka K, Kataoka T, Tanaka H et al (2018) A comparison of corrective osteotomies using dorsal and volar fixation for malunited distal radius fractures. Int Orthop 42:2873–2879. https://doi.org/10.1007/s00264-018-3972-1 CrossRefPubMed

10.

Martinez-Mendez D, Lizaur-Utrilla A, de Juan-Herrero J (2018) Prospective study of comminuted articular distal radius fractures stabilized by volar plating in the elderly. Int Orthop 42:2243–2248. https://doi.org/10.1007/s00264-018-3903-1 CrossRefPubMed

11.

Twigt B, Bemelman M, Lansink K, Leenen L (2013) Type C distal radial fractures treated with conventional AO plates: an easy and cost-saving solution in a locking plate era. Int Orthop 37:483–488. https://doi.org/10.1007/s00264-012-1761-9 CrossRefPubMedPubMedCentral

12.

Leixnering M, Rosenauer R, Pezzei C et al (2020) Indications, surgical approach, reduction and stabilization techniques of distal radius fractures. Arch Orthop Trauma Surg. https://doi.org/10.1007/s00402-020-03365-y CrossRefPubMedPubMedCentral

13.

Quadlbauer S, Pezzei C, Jurkowitsch J et al (2016) Early rehabilitation of distal radius fractures stabilized by volar locking plate: a prospective randomized pilot study. J Wrist Surg 06:102–112. https://doi.org/10.1055/s-0036-1587317 CrossRef

14.

Lozano-Calderón SA, Souer S, Mudgal C et al (2008) Wrist mobilization following volar plate fixation of fractures of the distal part of the radius. J Bone Jt Surg Ser A 90:1297–1304. https://doi.org/10.2106/JBJS.G.01368 CrossRef

15.

Osada D, Kamei S, Masuzaki K et al (2008) Prospective study of distal radius fractures treated with a volar locking plate system. J Hand Surg Am 33:691–700. https://doi.org/10.1016/j.jhsa.2008.01.024 CrossRefPubMed

16.

Lameijer CM, ten Duis HJ, van Dusseldorp I et al (2017) Prevalence of posttraumatic arthritis and the association with outcome measures following distal radius fractures in non-osteoporotic patients: a systematic review. Arch Orthop Trauma Surg 137:1499–1513. https://doi.org/10.1007/s00402-017-2765-0 CrossRefPubMedPubMedCentral

17.

Arora R, Lutz M, Deml C et al (2011) A Prospective randomized trial comparing nonoperative treatment with volar locking plate fixation for displaced and unstable distal radial fractures in patients sixty-five years of age and older. J Bone Jt Surg Am 93:2146–2153. https://doi.org/10.2106/JBJS.J.01597 CrossRef

18.

Arora R, Lutz M, Hennerbichler A et al (2007) Complications following internal fixation of unstable distal radius fracture with a palmar locking-plate. J Orthop Trauma 21:316–322. https://doi.org/10.1097/BOT.0b013e318059b993 CrossRefPubMed

19.

Haug LCP, Deml C, Blauth M, Arora R (2011) Dorsal screw penetration following implant removal after volar locked plating of distal radius fracture. Arch Orthop Trauma Surg 131:1279–1282. https://doi.org/10.1007/s00402-011-1300-y CrossRefPubMed

20.

Erhart S, Toth S, Kaiser P et al (2018) Comparison of volarly and dorsally displaced distal radius fracture treated by volar locking plate fixation. Arch Orthop Trauma Surg 138:879–885. https://doi.org/10.1007/s00402-018-2925-x CrossRefPubMed

21.

Quadlbauer S, Pezzei C, Jurkowitsch J et al (2017) Spontaneous radioscapholunate fusion after septic arthritis of the wrist: a case report. Arch Orthop Trauma Surg 137:579–584. https://doi.org/10.1007/s00402-017-2659-1 CrossRefPubMed

22.

Hardman J, Al-Hadithy N, Hester T, Anakwe R (2015) Systematic review of outcomes following fixed angle intramedullary fixation of distal radius fractures. Int Orthop 39:2381–2387. https://doi.org/10.1007/s00264-015-2763-1 CrossRefPubMed

23.

Hohendorff B, Knappwerth C, Franke J et al (2018) Pronator quadratus repair with a part of the brachioradialis muscle insertion in volar plate fixation of distal radius fractures: a prospective randomised trial. Arch Orthop Trauma Surg 138:1479–1485. https://doi.org/10.1007/s00402-018-2999-5 CrossRefPubMed

24.

Hohendorff B, Unglaub F, Spies CK et al (2019) Repair of the pronator quadratus muscle with a part of the brachioradialis muscle insertion in volar plate fixation of a distal radius fracture. Oper Orthop Traumatol. https://doi.org/10.1007/s00064-019-0601-0 CrossRefPubMed

25.

Kim JK, Park MG, Shin SJ (2014) What is the minimum clinically important difference in grip strength? Clin Orthop Relat Res 472:2536–2541. https://doi.org/10.1007/s11999-014-3666-y CrossRefPubMedPubMedCentral

26.

World Health Organization (1972) Psychogeriatrics. Report of a WHO scientific group. World Health Organ Tech Rep Ser 507:1–48

27.

Chaudhry H, Kleinlugtenbelt YV, Mundi R et al (2015) Are volar locking plates superior to percutaneous K-wires for distal radius fractures? A meta-analysis. Clin Orthop Relat Res 473:3017–3027CrossRef

28.

Beaton DE, Wright JG, Katz JN et al (2005) Development of the QuickDASH: comparison of three item-reduction approaches. J Bone Jt Surg Ser A 87:1038–1046. https://doi.org/10.2106/JBJS.D.02060 CrossRef

29.

Walenkamp MMJ, de Muinck Keizer R-J, Goslings JC et al (2015) The minimum clinically important difference of the patient-rated wrist evaluation score for patients with distal radius fractures. Clin Orthop Relat Res 473:3235–3241. https://doi.org/10.1007/s11999-015-4376-9 CrossRefPubMedPubMedCentral

30.

Hemelaers L, Angst F, Drerup S et al (2008) Reliability and validity of the german version of “the patient-rated wrist evaluation (PRWE)” as an outcome measure of wrist pain and disability in patients with acute distal radius fractures. J Hand Ther 21:366–376. https://doi.org/10.1197/j.jht.2008.03.002 CrossRefPubMed

31.

Cooney WP, Bussey R, Dobyns JH, Linscheid RL (1987) Difficult wrist fractures. Perilunate fracture-dislocations of the wrist. Clin Orthop Relat Res 214:136–147

32.

Veldman PH, Reynen HM, Arntz IE, Goris RJ (1993) Signs and symptoms of reflex sympathetic dystrophy: prospective study of 829 patients. Lancet (London, England) 342:1012–1016CrossRef

33.

Crijns TJ, van der Gronde BATD, Ring D, Leung N (2018) Complex regional pain syndrome after distal radius fracture is uncommon and is often associated with fibromyalgia. Clin Orthop Relat Res 476:744–750. https://doi.org/10.1007/s11999.0000000000000070 CrossRefPubMedPubMedCentral

34.

Müller ME, Koch P, Nazarian S, Schatzker J (1990) Tibia/Fibula= 4. The comprehensive classification of fractures of long bones. Springer, Berlin, pp 148–191CrossRef

35.

Ng CY, McQueen MM (2011) What are the radiological predictors of functional outcome following fractures of the distal radius? J Bone Joint Surg Br 93(B):145–150. https://doi.org/10.1302/0301-620X.93B2.25631 CrossRefPubMed

36.

Schmitt R, Pommersberger K (2014) Karpale Funktion und Morphometerie. In: Schmitt R, Lanz U (eds) Bildgebende Diagnostik der Hand, 3rd edn. Thieme, Germany, pp 184–197

37.

Soong M, Earp BE, Bishop G et al (2011) Volar locking plate implant prominence and flexor tendon rupture. J Bone Jt Surg Ser A 93:328–335. https://doi.org/10.2106/JBJS.J.00193 CrossRef

38.

Schlickum L, Quadlbauer S, Pezzei C et al (2018) Three-dimensional kinematics of the flexor pollicis longus tendon in relation to the position of the FPL plate and distal radius width. Arch Orthop Trauma Surg. https://doi.org/10.1007/s00402-018-3081-z CrossRefPubMed

39.

Cohen J (1988) Differences between correlation coefficients. In: Cohen J (ed) Statistical power analysis for the behavioral sciences, 2nd edn. Lawrence Erlbaum Associates, New Jersey, pp 109–145

40.

Weil NL, El Moumni M, Rubinstein SM et al (2017) Routine follow-up radiographs for distal radius fractures are seldom clinically substantiated. Arch Orthop Trauma Surg 137:1187–1191. https://doi.org/10.1007/s00402-017-2743-6 CrossRefPubMedPubMedCentral

41.

Weschenfelder W, Friedel R, Hofmann GO, Lenz M (2019) Acute atraumatic carpal tunnel syndrome due to flexor tendon rupture following palmar plate osteosynthesis in a patient taking rivaroxaban. Arch Orthop Trauma Surg 139:435–438. https://doi.org/10.1007/s00402-019-03116-8 CrossRefPubMed

42.

Janssen SJ, Teunis T, Guitton TG et al (2015) Do surgeons treat their patients like they would treat themselves? Clin Orthop Relat Res 473:3564–3572. https://doi.org/10.1007/s11999-015-4304-z CrossRefPubMedPubMedCentral

43.

Fok MWM, Fang CX, Lau TW et al (2018) The status of triangular fibrocartilage complex after the union of distal radius fractures with internal plate fixation. Int Orthop 42:1917–1922. https://doi.org/10.1007/s00264-018-3793-2 CrossRefPubMed

44.

Diwersi N, Babst R, Link B-C (2016) Miniplates as augmentation implants in osteosynthesis of complex distal radial fractures. Oper Orthop Traumatol 28:402–406. https://doi.org/10.1007/s00064-016-0469-1 CrossRefPubMed

45.

Pillukat T, Fuhrmann R, Windolf J, van Schoonhoven J (2016) Die palmare winkelstabile Plattenosteosynthese bei Extensionsfrakturen des distalen Radius. Oper Orthop Traumatol 28:47–64. https://doi.org/10.1007/s00064-015-0433-5 CrossRefPubMed

46.

Babikir EME, Al-Maqdassy ED, Hasan K et al (2017) Efficiency of fragment specific fixation plates in the treatment of comminuted distal radial fractures. Int Orthop 41:1763–1769. https://doi.org/10.1007/s00264-017-3516-0 CrossRefPubMed

47.

Gamba C, Fernandez FAM, Llavall MC et al (2017) Which immobilization is better for distal radius fracture? A prospective randomized trial. Int Orthop 41:1723–1727. https://doi.org/10.1007/s00264-017-3518-y CrossRefPubMed

48.

Zhang B, Chang H, Yu K et al (2017) Intramedullary nail versus volar locking plate fixation for the treatment of extra-articular or simple intra-articular distal radius fractures: systematic review and meta-analysis. Int Orthop 41:2161–2169. https://doi.org/10.1007/s00264-017-3460-z CrossRefPubMed

49.

Quadlbauer S, Pezzei C, Jurkowitsch J et al (2020) Rehabilitation after distal radius fractures - is there a need for immobilization and physiotherapy? Arch Orthop Trauma Surg. https://doi.org/10.1007/s00402-020-03367-w CrossRefPubMedPubMedCentral

50.

Alter TH, Sandrowski K, Gallant G et al (2019) Complications of volar plating of distal radius fractures: a systematic review. J Wrist Surg 08:255–262. https://doi.org/10.1055/s-0038-1667304 CrossRef

51.

Vannabouathong C, Hussain N, Guerra-Farfan E, Bhandari M (2019) Interventions for distal radius fractures. J Am Acad Orthop Surg 27:e596–e605. https://doi.org/10.5435/JAAOS-D-18-00424 CrossRefPubMed

52.

Reynolds PJ (2014) The correlation of radiographic outcome to functional outcome following fracture of the distal radius in elderly patients: a literature review. Hand Ther 19:31–39. https://doi.org/10.1177/1758998314527069 CrossRef

53.

Mulders MAM, Detering R, Rikli DA et al (2018) Association between radiological and patient-reported outcome in adults with a displaced distal radius fracture: a systematic review and meta-analysis. J Hand Surg Am 43:710–719.e5. https://doi.org/10.1016/j.jhsa.2018.05.003 CrossRefPubMed

54.

Brogren E, Hofer M, Petranek M et al (2011) Relationship between distal radius fracture malunion and arm-related disability: a prospective population-based cohort study with 1-year follow-up. BMC Musculoskelet Disord 12:9. https://doi.org/10.1186/1471-2474-12-9 CrossRefPubMedPubMedCentral

55.

Grewal R, MacDermid JC (2007) The risk of adverse outcomes in extra-articular distal radius fractures is increased with malalignment in patients of all ages but mitigated in older patients. J Hand Surg Am 32:962–970. https://doi.org/10.1016/j.jhsa.2007.05.009 CrossRefPubMed

56.

Orbay JL, Fernandez DL (2002) Volar fixation for dorsally displaced fractures of the distal radius: a preliminary report. J Hand Surg Am 27:205–215. https://doi.org/10.1053/jhsu.2002.32081 CrossRefPubMed

57.

Orbay JL, Fernandez DL (2004) Volar fixed-angle plate fixation for unstable distal radius fractures in the elderly patient. J Hand Surg Am 29:96–102CrossRef

58.

Quadlbauer S, Leixnering M, Jurkowitsch J et al (2017) Volar radioscapholunate arthrodesis and distal scaphoidectomy after malunited distal radius fractures. J Hand Surg Am 42:754.e1–754.e8. https://doi.org/10.1016/j.jhsa.2017.05.031 CrossRef

59.

Arora R, Gschwentner M, Krappinger D et al (2007) Fixation of nondisplaced scaphoid fractures: making treatment cost effective. Prospective controlled trial. Arch Orthop Trauma Surg 127:39–46. https://doi.org/10.1007/s00402-006-0229-z CrossRefPubMed

60.

Rosenauer R, Pezzei C, Quadlbauer S et al (2020) Complications after operatively treated distal radius fractures. Arch Orthop Trauma Surg. https://doi.org/10.1007/s00402-020-03372-z CrossRefPubMedPubMedCentral

61.

Keuchel T, Quadlbauer S, Jurkowitsch J et al (2020) Salvage procedure after malunited distal radius fractures and management of pain and stiffness. Arch Orthop Trauma Surg. https://doi.org/10.1007/s00402-020-03369-8 CrossRefPubMedPubMedCentral

62.

Soong M, Van Leerdam R, Guitton TG et al (2011) Fracture of the distal radius: risk factors for complications after locked volar plate fixation. J Hand Surg Am 36:3–9. https://doi.org/10.1016/j.jhsa.2010.09.033 CrossRefPubMed

63.

Protopsaltis TS, Ruch DS (2008) Volar approach to distal radius fractures. J Hand Surg Am 33:958–965. https://doi.org/10.1016/j.jhsa.2008.04.018 CrossRefPubMed

64.

Rampoldi M, Marsico S (2007) Complications of volar plating of distal radius fractures. Acta Orthop Belg 73:714–719. https://doi.org/10.1016/j.jhsa.2014.03.038 CrossRefPubMed

65.

Quadlbauer S, Leixnering M, Rosenauer R et al (2020) Palmar radioscapholunate arthrodesis with distal scaphoidectomy. Oper Orthop Traumatol. https://doi.org/10.1007/s00064-020-00651-1 CrossRefPubMed

66.

Bentohami A, De Burlet K, De Korte N et al (2014) Complications following volar locking plate fixation for distal radial fractures: a systematic review. J Hand Surg Eur 39:745–754. https://doi.org/10.1177/1753193413511936 CrossRef

67.

Roh YH, Lee BK, Noh JH et al (2014) Factors associated with complex regional pain syndrome type I in patients with surgically treated distal radius fracture. Arch Orthop Trauma Surg 134:1775–1781. https://doi.org/10.1007/s00402-014-2094-5 CrossRefPubMed

68.

Üçeyler N, Eberle T, Rolke R et al (2007) Differential expression patterns of cytokines in complex regional pain syndrome. Pain 132:195–205. https://doi.org/10.1016/j.pain.2007.07.031 CrossRefPubMed

69.

Nickel FT, Maihöfner C (2010) Aktuelle Erkenntnisse zur Pathophysiologie des CRPS I. Handchirurgie Mikrochirurgie Plast Chir 42:8–14. https://doi.org/10.1055/s-0029-1246211 CrossRef

70.

Tanl ECT, Janssenl AJM, Roestenbergl P et al (2011) Mitochondrial dysfunction in muscle tissue of complex regional pain syndrome type I patients. Eur J Pain 15:708–715. https://doi.org/10.1016/j.ejpain.2010.12.003 CrossRef

Titel: Functional and radiological outcome of distal radius fractures stabilized by volar-locking plate with a minimum follow-up of 1 year
verfasst von: Stefan Quadlbauer
Ch. Pezzei
J. Jurkowitsch
R. Rosenauer
A. Pichler
S. Schättin
T. Hausner
M. Leixnering
Publikationsdatum: 27.03.2020
Verlag: Springer Berlin Heidelberg
Erschienen in: Archives of Orthopaedic and Trauma Surgery / Ausgabe 6/2020
Print ISSN: 0936-8051
Elektronische ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-020-03411-9

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