Original Communications
Volar fixation for dorsally displaced fractures of the distal radius: A preliminary report*,**

https://doi.org/10.1053/jhsu.2002.32081Get rights and content

Abstract

Using a volar approach to avoid the soft tissue problems associated with dorsal plating, we treated a consecutive series of 29 patients with 31 dorsally displaced, unstable distal radial fractures with a new fixed-angle internal fixation device. At a minimal follow-up time of 12 months the fractures had healed with highly satisfactory radiographic and functional results. The final volar tilt averaged 5°; radial inclination, 21°; radial shortening, 1 mm; and articular incongruity, 0 mm. Wrist motion at final follow-up examination averaged 59° extension, 57° flexion, 27° ulnar deviation, 17° radial deviation, 80° pronation, and 78° supination. Grip strength was 79% of the contralateral side. The overall outcome according to the Gartland and Werley scales showed 19 excellent and 12 good results. Our experience indicates that most dorsally displaced distal radius fractures can be anatomically reduced and fixed through a volar approach. The combination of stable internal fixation with the preservation of the dorsal soft tissues resulted in rapid fracture healing, reduced need for bone grafting, and low incidence of tendon problems in our study. (J Hand Surg 2002;27A:205–215. Copyright © 2002 by the American Society for Surgery of the Hand.)

Section snippets

Materials and methods

From January 1, 1998, to December 31, 1998, we undertook a prospective study to evaluate the effectiveness of volar fixed-angle plate fixation of dorsally displaced unstable distal radial fractures in 2 institutions (Miami Hand Center, Miami, FL, and Lindenhof Hospital, Berne, Switzerland). The study was approved by corresponding institutional review boards, and informed consent was obtained from all patients. Criteria for study inclusion were a dorsally displaced fracture of the distal radius

Results

All cases were accounted for and had an average follow-up time of 12.5 months (range, 53–98 weeks). The average time to radiographic healing was 5.6 weeks (range, 5–8.2 weeks). Seventeen patients who were employed at the time of injury all were able to return to work within 16 weeks of injury. The remaining 12 patients, including 10 elderly patients (>65 years old) and 2 students, returned to their preinjury everyday activities. Nineteen patients attended physical therapy and 10 did

Discussion

The primary goal in treatment of unstable fractures of the distal radius is to achieve optimal restoration of the disrupted anatomy and allow quick return of hand function, while preventing secondary fracture displacement. If the fracture has a displaced intra-articular component, additional efforts to secure and maintain anatomic reduction of the joint surface should be undertaken. If these goals are achieved, better final functional results are to be expected. Early wrist motion has been

References (22)

  • LM Hove et al.

    Open reduction and internal fixation of displaced intraarticular fractures of the distal radius: 31 patients followed for 3 to 7 years

    Acta Orthop Scand

    (1997)
  • Cited by (454)

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    *

    The author or one or more of the authors have received or will receive benefits for personal or professional use from a commercial party related directly or indirectly to the subject of this article.

    **

    Reprint requests: Jorge L. Orbay, MD, Miami Hand Center, 8905 SW 87 Ave, Suite 100, Miami, FL 33176.

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