Outcome analysis of Intra-articular distal end radius fracture treated with volar plating
Abstract
Fractures of distal end radius are most common fractures of the upper limb. Various techniques have been described including closed reduction, percutaneous fixation and open reduction and fixation. This study was conducted to assess the functional and radiological outcomes of volar plate osteosynthesis to manage intra-articular distal end radius fracture. For this study, 30 patients with intraarticular distal end radius fractures involving radiocarpal joint operated with open reduction and internal fixation with the volar plate were taken. Minimum follow up 6 months were done. During the follow-up, radiological parameters were assessed in terms of radial length, radial inclination, radial (palmar) tilt, articular step-off, functional parameters were assessed in terms of range of motion i.e.dorsifleion, plantar flexion, pronation, supination radial and ulnar deviation and Gartland and Werley score. Mean age of patients was 46.8 years with male: female ratio 6:4. Mean radial height was 11.2mm, mean radial inclination was 21.8 degree and mean radial (palmar) tilt was 10 degrees. Average Gartland and Werley score was 3.6. Average dorsiflexion was 71 degrees, palmar flexion was 68 degrees, mean radial deviation was 16 degrees and mean ulnar deviation was 29 degrees. Mean pronation was 72 degrees and mean supination was 75 degrees. It was concluded that volar plating has good outcome for intraarticular distal end fractures of radius with minimal complications. So, it should be considered as the first line of management for intraarticular distal end radius fracture.
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Introduction
Distal end radius fractures are the most common fractures of the upper extremity accounts for approximately 16-20% of all skeletal fractures world wide. 1-2 In younger patients, most common cause is road traffic accident while in elderly patients, most common cause is fall on outstretched hand. Around 50% of these fractures are intra-articular.
Distal end radius fractures was first described by the Irish surgeon and anatomist Abraham Colles in 1814.3 His description was based on clinical examination alone. It was low energy, extraarticular, dorsally displaced fracture. It is popularly known as Colles fracture while low energy extraarticular volarly displaced fracture is Smiths fracture. Barton'fracture is intraarticular volar or dorsal lip of radiocarpal joint. Chauffer'sfracture is radial styloid fracture. There are many radiological classifications like Fernandez classification based on the mechanism of injury, Frykman classification4 based on joint involvement (radiocarpal/radioulnar and/or ulnar styloid fracture) and Melone's classification based on the displacement of intra-articular fragments and AO.
Conclusion
This present study concludes that males were more affected than female and fall on outstretched hand was the most common mechanism of injury. Ranges of motion at the wrist were satisfactory. So it can be concluded that open reduction and internal fixation with volar plating is an effective procedure to treat distal end radius fracture. However, a large group with long term follow-up is needed.