Fractures of distal end radius account for one sixth of all fractures that are seen and treated by orthopaedic surgeons. Increasing functional demand and improved methodologies of achieving and maintaining anatomical reduction, restoration of length, angulation and congruity of joint have generated renewed interest in addressing the anecdotal comments in more precise manner. Plating is a technique to restore and maintain the radial length and prevention of metaphyseal collapse. The focus of our interest in this study is to evaluate the outcome of plating in fractures of lower end of radius.
Methods: We reviewed 36 patients treated for distal radius fractures using a plate. All patients were treated by volar plating using Henry’s volar approach for distal radius. Postoperative management included immediate finger movements, limb elevation and wrist immobilization for 4-6 weeks depending on fracture pattern and followed by wrist range of movement physiotherapy. Patients were followed for total 6 months-5 years. Radiographs of wrist joint were taken as well as movements in the form of dorsiflexion, palmerflexion, pronation, supination, radial deviation, ulnar deviation and hand grip were assessed at every follow up for all patients. At every follow up, patients were assessed using Gartland and Werley’s Demerit Scoring System for the result of plating of distal radius fracture. Patients were also evaluated for radiological outcome at immediate postoperative and at final follow up, in the form of radial length, radial inclination and volar tilt.
Results: Fracture union had occurred in all patients at the mean time of follow-up of 9.5 weeks. On X-rays taken at the time of follow-up, 31 patients (86.10%) had achieved acceptable radial length that is radial shortening <5 mm at distal radioulnar joint. 5 patients (13.90%) had a radial shortening of 5 mm. The mean radial length was 9.61 mm. The mean radial inclination was on average 21.53° and the volar tilt was on average 4.22°. Our patients had mean dorsiflexion 66.22°, mean palmer flexion 56.86°, mean supination 74.61°, mean pronation 70.91°, mean radial deviation 14.94° and mean ulnar deviation 28° at final follow up. Out of 36 patients, total 32 patients (88.90%) had excellent and good outcome as per subjective evaluation in Gartland and Werley’s demerit score system. Asymptomatic tenosynovitis was found most commonly than any other complications. Gartland and Werley’s Criteria results yielded an excellent outcome in 21 cases(58.33%), a good outcome in 12 cases (33.33%) and a fair outcome in 3 cases (8.33%).The fair results were due to difficulty in getting primary reduction with the persistence of incongruity of the radio-carpal and the distal radio-ulnar joints, incomplete restoration of radial length.
Conclusion: Distal radius fractures in our study, are more common in young and middle aged (20 to 59 years) males who had sustained high velocity trauma (RTA). This favours that young male sustaining road traffic accidents are more prone to intra-articular, displaced distal radius fracture than extra articular fracture and elder patients, who have osteoporotic fracture.Locking plate used for fixation of intra-articular, displaced, lower end radius fracture, gives excellent to good result. This means that, plating in unstable intra-articular fracture of distal end radius using locked plates has become an effective tool in the management of difficult injuries. Anatomical restoration of articular congruency along with restoration of radial length and reduction of the dorsal tilt to volar, having great importance with regards to long term outcomes.