J Korean Orthop Assoc.  2011 Oct;46(5):387-391.

The Results of Unstable Distal Radius Fracture Following Volar Locking Plate Fixation in Elderly Patients

• Kim JK
• Rhee SJ

Abstract

PURPOSE
The purposes of this prospective study were to find out whether the reduction is maintained 1 year after the volar locking plate fixation of unstable distal radius fracture in elderly patients, and to evaluate the effect of the patient's age and bone mineral density (BMD) on the maintenance of radiographic reduction.
MATERIALS AND METHODS
Thirty-eight patients aged 65 years or older, with an unstable distal radius fracture were treated by open reduction and internal fixation with the volar locking plate system. Plain radiographs of the wrist, obtained immediately after surgery, were compared with those taken 1 year postoperatively. The evaluated radiographic parameters included radial inclination, volar tilt, ulnar variance and step off. The authors also evaluated correlations between patient factors of age and BMD and the postoperative changes of the four radiographic parameters.
RESULTS
Initial surgical reduction of unstable distal radius fractures was maintained in all 38 patients for 1 year after surgery. No significant correlation was found between patient factors of age, and BMD and the postoperative changes of radiographic parameters during the first year after surgery.
CONCLUSION
Using volar locking plate for initial reduction was maintained until bony union in elderly patients and showed satisfactory outcome. Also, there was no correlation found in between postoperative changes of radiographic parameters, and the age of patients and BMD until the final bony union.

Keyword

elderly; distal radius fracture; volar locking plate

MeSH Terms

Aged
Bone Density
Humans
Prospective Studies
Radius
Radius Fractures
Wrist

Figure

• 

  Figure 1 (A) Anteroposterior and lateral radiographs of wrist in a 70-year-old female (AO C2 type fracture). (B) Postoperative anteroposterior and lateral radiographs. (C) Postoperative 1 year anteroposterior and lateral radiographs.

Reference

1. Makhni EC, Ewald TJ, Kelly S, Day CS. Effect of patient age on the radiographic outcomes of distal radius fractures subject to nonoperative treatment. J Hand Surg Am. 2008. 33:1301–1308.

2. Ring D, Jupiter JB. Treatment of osteoporotic distal radius fractures. Osteoporos Int. 2005. 16:Suppl 2. S80–S84.

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

4. Ring D. Treatment of the neglected distal radius fracture. Clin Orthop Relat Res. 2005. 431:85–92.

5. Chung KC, Shauver MJ, Birkmeyer JD. Trends in the United States in the treatment of distal radial fractures in the elderly. J Bone Joint Surg Am. 2009. 91:1868–1873.

6. Goldfarb CA, Yin Y, Gilula LA, Fisher AJ, Boyer MI. Wrist fractures: what the clinician wants to know. Radiology. 2001. 219:11–28.

7. Medoff RJ. Essential radiographic evaluation for distal radius fractures. Hand Clin. 2005. 21:279–288.

8. Cooney WP, Linscheid RL, Dobyns JH. Triangular fibrocartilage tears. J Hand Surg Am. 1994. 19:143–154.

9. Hudak PL, Amadio PC, Bombardier C. The Upper Extremity Collaborative Group (UECG). Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand) [corrected]. Am J Ind Med. 1996. 29:602–608.

10. Chung KC, Squitieri L, Kim HM. Comparative outcomes study using the volar locking plating system for distal radius fractures in both young adults and adults older than 60 years. J Hand Surg Am. 2008. 33:809–819.

11. Mackenney PJ, McQueen MM, Elton R. Prediction of instability in distal radial fractures. J Bone Joint Surg Am. 2006. 88:1944–1951.

12. Aro HT, Koivunen T. Minor axial shortening of the radius affects outcome of Colles' fracture treatment. J Hand Surg Am. 1991. 16:392–398.

13. Gehrmann SV, Windolf J, Kaufmann RA. Distal radius fracture management in elderly patients: a literature review. J Hand Surg Am. 2008. 33:421–429.

14. Slutsky DJ. Predicting the outcome of distal radius fractures. Hand Clin. 2005. 21:289–294.

15. Jupiter JB, Ring D, Weitzel PP. Surgical treatment of redisplaced fractures of the distal radius in patients older than 60 years. J Hand Surg Am. 2002. 27:714–723.

16. Chen NC, Jupiter JB. Management of distal radial fractures. J Bone Joint Surg Am. 2007. 89:2051–2062.

17. Itoh S, Tomioka H, Tanaka J, Shinomiya K. Relationship between bone mineral density of the distal radius and ulna and fracture characteristics. J Hand Surg Am. 2004. 29:123–130.

18. Clayton RA, Gaston MS, Ralston SH, Court-Brown CM, McQueen MM. Association between decreased bone mineral density and severity of distal radial fractures. J Bone Joint Surg Am. 2009. 91:613–619.