Arch Hand Microsurg.  2019 Mar;24(1):24-31. 10.12790/ahm.2019.24.1.24.

The Effect of Volar Locking Plate Leveraging on Restoring Volar Tilt of Distal Radius Fractures

• Kang HV
• Im JH
• Choi JH
• Oh JH
• Kang SH
• Lee JY

• KMID: 2440608
• DOI: http://doi.org/10.12790/ahm.2019.24.1.24

Abstract

PURPOSE
The purpose of the study was to analyze the radiologic and clinical outcomes of volar locking plate leveraging technique comparing to conventional technique and to prove the effect of volar locking plate leveraging technique on restoring volar tilt of distal radius fractures.
METHODS
From January 2011 to December 2015, 196 patients (50 males and 146 females) who underwent operative treatment of distal radius fracture met the inclusion criteria and retrospectively analyzed. We defined group 1 (n=93, 23 males and 70 females) as patients who were operated by conventional method, and group 2 (n=103, 27 male and 76 females) as patients who were operated by volar locking plate leveraging technique. Postoperative radiographic parameters including radial inclination, radial length, and volar tilt were measured as radiologic outcomes and range of motion, pain visual analogue scale, grip strength, shortened disabilities of arm, shoulder and hand questionnaire were measured as clinical outcomes.
RESULTS
Postoperative radial inclination, radial length, and volar tilt in group 1 was 24.22°, 12.02 mm, and 9.31°, in group 2 was 25.64°, 12.40 mm, and 11.48°. There was statistically significant difference in postoperative volar tilt (p=0.008). There were no statistic differences in other radiologic parameters and clinical outcomes.
CONCLUSION
Volar locking plate leveraging technique is reliable and predictable technique for restoration of anatomical parameters of distal radius fracture, especially volar tilt.

Keyword

Distal radius fracture; Volar tilt; Reduction technique; Plate leverage; Volar locking plate

MeSH Terms

Arm
Hand
Hand Strength
Humans
Male
Methods
Radius Fractures*
Radius*
Range of Motion, Articular
Retrospective Studies
Shoulder

Figure

• 

  Fig. 1 Conventional method. (A) A 74-year-old female patient slipped on the road and diagnosed as dorsally angulated distal radius fracture. (B) Distal fracture fragment had been temporarily fixed by K-wire and proximal portion of volar locking plate was fixed. The manual reduction force was maintained to fix further distal locking screws. (C) Distal locking screws were fixed one by one while confirming the direction and depth of the screws using fluoroscopy. (D) Length and direction of the screws were appropriate and volar tilt was restored.

• 

  Fig. 2 Volar locking plate leveraging method. (A) A 27-year-old female patient slipped in the mountains and diagnosed as dorsally angulated distal radius fracture. (B, C) After manual reduction of fracture fragment, distal portion of the volar locking plate was fixed at the distal fragment. To restore volar tilt and radial inclination, proximal portion of locking plate was elevated and deviated ulnarly from center of radial shaft. (D, E) After applying all the distal screws, proximal portion of the plate was attached to the center of radial shaft. At this time, volar tilt and radial inclination were restored simultaneously, and volar locking plate functioned as a leverage.

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