Orthopedics

Feature Articles 

Palmar Locking Plates for Corrective Osteotomy of Latent Malunion of Dorsally Tilted Distal Radial Fractures Without Structural Bone Grafting

Yih-Wen Tarng, MD; Shan-Wei Yang, MD; Chien-Jen Hsu, MD

Abstract

The purpose of this retrospective study was to investigate the clinical and radiological outcomes following corrective osteotomy for nascent malunion of distal radial fractures with dorsal tilt using palmar-locking plates without using autologous structural bone grafting for dorsal cortex support. The fractures were dorsally angulated distal radial fractures (AO types A2, A3, and C1) with neglected or delayed treatment for 5 to 8 weeks. Fractures were repaired using 2.4-mm palmar locking plates. Dorsal cortical defects at the osteotomy sites were filled with incipient healing callus. Radiographs were obtained before correction and at 2 and 6 weeks and 3, 4.5, 6, and 12 months postoperatively. Palmar tilt, radial inclination, and ulnar variance were measured. There were no cases of loss reduction, implant failure, or delayed fracture union without structural bone graft and casting. Clinical assessments included active range of motion of the wrist and function based on the Mayo Wrist Score. Even with wrist immobilization for >1 month preoperatively, all patients had excellent Mayo Wrist Scores at 4.5 months due to early postoperative rehabilitation. No further changes were apparent between 4.5- and 12-month follow-up.

The palmar locking plates provided sufficient stability for corrective osteotomy within 8 weeks of injury without the need for structural bone grafting. Furthermore, casting immobilization was also unnecessary, and a good wrist range of motion was restored early after rehabilitation.

Drs Tarng and Yang are from the Department of Emergency and Dr Hsu is from the Department of Orthopedic Surgery, Kaohsiung Veterans General Hospital, and Drs Tarng and Hsu are also from the Department of Physical Therapy, Shu Zen College of Medicine and Management, Kaohsiung City, Taiwan.

Drs Tarng, Yang, and Hsu have no relevant financial relationships to disclose.

Distal radial fractures are common extremity fractures often treated successfully by closed reduction. 1–5 However, in some cases, loss of reduction or malunion may occur despite successful closed reduction and casting. 1–5 Unacceptable malalignment—defined as radial shortening >3 mm, radial inclination <15°, dorsal tilt >10°, and velar tilt >20°—can be associated with wrist pain, deformity, and limited functional range of motion (ROM). 1–5 Therefore, the goals of surgical treatment are restoration of axial alignment, maintenance of reduction, preservation of wrist function, and pain relief. 1–8

Several surgical options exist for treating unacceptable malalignment associated with distal radial fracture. These include opening wedge osteotomy and bone grafting with cast or wrist external skeletal fixator stabilization, supplemental K-wire fixation, and a variety of volar or dorsal plate fixation and gradual distraction with external fixation techniques. 1–8 We favor open reduction with plate fixation, as this allows for accurate restoration of bony anatomy and stable internal fixation and is associated with a shortened period of immobilization and an early return of wrist function.

Structural autologous bone grafting is commonly used to support the dorsal cortex of malunited distal radial fractures with dorsal tilt during opening wedge corrective osteotomy involving conventional T-plate fixation through a volar approach. 1,6–8 There is a risk of morbidity associated with the harvesting of autologous bone for grafting, and consequently some surgeons have proposed that a dorsal approach, involving dorsal buttress plating, is a better option for reducing the dorsally tilted distal fragment. The technique facilitates restoration of the dorsal cortex and allows for early recovery of wrist joint motion, without the need for structural bone grafting. 9,10 Dorsal cortex collapse is not a concern with this approach. However, irritation and rupture of the extensor tendons can be a complication of dorsal buttress plating, even when Lister’s tubercle is removed. 11–13

Among the recently developed plates for internal fixation of the distal radius, palmar locking plates have…

Abstract

The purpose of this retrospective study was to investigate the clinical and radiological outcomes following corrective osteotomy for nascent malunion of distal radial fractures with dorsal tilt using palmar-locking plates without using autologous structural bone grafting for dorsal cortex support. The fractures were dorsally angulated distal radial fractures (AO types A2, A3, and C1) with neglected or delayed treatment for 5 to 8 weeks. Fractures were repaired using 2.4-mm palmar locking plates. Dorsal cortical defects at the osteotomy sites were filled with incipient healing callus. Radiographs were obtained before correction and at 2 and 6 weeks and 3, 4.5, 6, and 12 months postoperatively. Palmar tilt, radial inclination, and ulnar variance were measured. There were no cases of loss reduction, implant failure, or delayed fracture union without structural bone graft and casting. Clinical assessments included active range of motion of the wrist and function based on the Mayo Wrist Score. Even with wrist immobilization for >1 month preoperatively, all patients had excellent Mayo Wrist Scores at 4.5 months due to early postoperative rehabilitation. No further changes were apparent between 4.5- and 12-month follow-up.

The palmar locking plates provided sufficient stability for corrective osteotomy within 8 weeks of injury without the need for structural bone grafting. Furthermore, casting immobilization was also unnecessary, and a good wrist range of motion was restored early after rehabilitation.

Drs Tarng and Yang are from the Department of Emergency and Dr Hsu is from the Department of Orthopedic Surgery, Kaohsiung Veterans General Hospital, and Drs Tarng and Hsu are also from the Department of Physical Therapy, Shu Zen College of Medicine and Management, Kaohsiung City, Taiwan.

Drs Tarng, Yang, and Hsu have no relevant financial relationships to disclose.

Correspondence should be addressed to: Chien-Jen Hsu, MD, Department of Orthopedic Surgery, Kaohsiung Veterans General Hospital, 386, Da-Chung 1st Rd, Kaohsiung City, Taiwan (qm1047@ms35.hinet.net).
Posted Online: June 14, 2011

Distal radial fractures are common extremity fractures often treated successfully by closed reduction. 1–5 However, in some cases, loss of reduction or malunion may occur despite successful closed reduction and casting. 1–5 Unacceptable malalignment—defined as radial shortening >3 mm, radial inclination <15°, dorsal tilt >10°, and velar tilt >20°—can be associated with wrist pain, deformity, and limited functional range of motion (ROM). 1–5 Therefore, the goals of surgical treatment are restoration of axial alignment, maintenance of reduction, preservation of wrist function, and pain relief. 1–8

Several surgical options exist for treating unacceptable malalignment associated with distal radial fracture. These include opening wedge osteotomy and bone grafting with cast or wrist external skeletal fixator stabilization, supplemental K-wire fixation, and a variety of volar or dorsal plate fixation and gradual distraction with external fixation techniques. 1–8 We favor open reduction with plate fixation, as this allows for accurate restoration of bony anatomy and stable internal fixation and is associated with a shortened period of immobilization and an early return of wrist function.

Structural autologous bone grafting is commonly used to support the dorsal cortex of malunited distal radial fractures with dorsal tilt during opening wedge corrective osteotomy involving conventional T-plate fixation through a volar approach. 1,6–8 There is a risk of morbidity associated with the harvesting of autologous bone for grafting, and consequently some surgeons have proposed that a dorsal approach, involving dorsal buttress plating, is a better option for reducing the dorsally tilted distal fragment. The technique facilitates restoration of the dorsal cortex and allows for early recovery of wrist joint motion, without the need for structural bone grafting. 9,10 Dorsal cortex collapse is not a concern with this approach. However, irritation and rupture of the extensor tendons can be a complication of dorsal buttress plating, even when Lister’s tubercle is removed. 11–13

Among the recently developed plates for internal fixation of the distal radius, palmar locking plates have been shown to be efficacious for the fixation of dorsally displaced distal radial fractures without the need for autologous bone grafting. 14–18

To date, however, the question remains as to whether palmar locking plates have sufficient strength to stabilize corrective osteotomies associated with repair of latent dorsally tilted distal radial fractures without supporting structural bone grafting. This article reports the clinical and radiological outcomes from a series of patients in whom corrective osteotomies were performed using palmar locking plates for repair of latent malunion dorsally tilted distal radius fractures. Neither autologous grafts from iliac bone nor bone substitutes were used.

Materials and Methods

Between July 2006 and January 2008, seven patients with latent malunion of distal radial fractures were treated using 2.4-mm AO palmar locking plates (Synthes, Welwyn Garden City, Herts, United Kingdom) for fixation. The cohort comprised 4 women and 3 men with a mean age of 55.7 years (range, 34–76 years). The average time between initial injury and surgical repair was 6.3 weeks (range, 5–8 weeks). Five patients were initially treated by casting following loss of reduction. The other 2 patients had neglected fractures and had received no prior medical management. The fractures were classified as type A2 (3 cases), type A3 (2 cases), and type C1 (2 cases) according to the AO fracture classification system. Patient information (clinical and radiological) is summarized in Table .

Summary of Data

Table 1. Summary of Data

Study inclusion criteria were latent malunion between initial injury and surgical repair of between 5 and 8 weeks and an A2, A3, or C1 fracture type. We chose this time frame as fractures <5 weeks old are considered to be acute fractures and do not require corrective osteotomy and bone grafting. Older fractures, however, typically require soft tissue release and periosteal stripping over the dorsal cortex and then bone grafting to support the dorsal cortical defect and prevent dorsal tilting. The upper limit of 8 weeks was selected as after this time the incipient healing callus surrounding the fracture often becomes calcified and hard. The 3 fracture types were chosen as all involve similar surgical repair procedures and have similar postoperative recoveries. Hence, comparisons between these fracture types can be readily made. Patients with C2 and C3 fracture types were excluded as the surgical procedures and postoperative recovery processes are dissimilar to those associated with the aforementioned fracture types.

Standard anteroposterior and lateral radiographs were obtained preoperatively and 2 and 6 weeks and 3, 4.5, 6, and 12 months postoperatively. Radiological measurements included angles of palmar tilt and radial inclination, as well as ulnar variance. Clinical evaluations were performed at 6 weeks and 3, 4.5, 6, and 12 months postoperatively and included determinations of wrist joint active ROM and the Mayo Wrist Score. The wrist joint active ROM assesses wrist flexion, extension, supination, and pronation. The modified Mayo Wrist Score assesses wrist function with respect to pain, work status, ROM, and grip strength. Scores ranging from 91 to 100 are excellent, 80 to 90 good, 65 to 79 fair, and <65 poor.

Surgical Technique

Surgery was performed under general anesthesia with the placement of an upper-arm tourniquet. General anesthesia was used to allow for the possibility of iliac crest grafting. Two incisions were made for the dorsal and palmar approaches. The palmar approach was made along the flexor carpi radialis tendon to expose the discontinued cortex over the palmar surface of the distal radius after incising the pronator quadratus muscle sharply from its radial insertion. Another discontinued dorsal cortex was found with surrounding soft callus between the third and fourth dorsal compartment via a dorsal approach. The soft tissue was released around the fracture site, and 2 parallel 1.6-mm K-wires were placed to the fracture site. Using the K-wires as a reference point, the fracture plane was verified on the lateral view by C-arm image intensifier. The latent malunited fracture site was split by osteotome chisel (4 cases) or oscillating saw (3 cases >7 weeks) from the dorsal cortex. All osteotomies were performed proximal to Lister’s tubercle, with an average dorsal incision length of 3 cm (range, 2.5–4 cm). The distal fragment was lifted from the dorsal aspect. To correct dorsal tilt and radial inclination, the volar cortex was left intact, allowing the osteotomy to hinge open at the intact cortex. Anatomic reduction was confirmed by intraoperative radiography, and the osteotomy site was temporarily stabilized by K-wires.

The contoured plate was placed as distally as possible on the palmar aspect. A 2.7-mm cortical screw was driven into the gliding hole on the shaft, and the plate position was adjusted to achieve appropriate positioning. Five 2.4-mm locking screws were placed subchondrally to fix the plate without penetrating the dorsal cortex. The last screw was inserted at the most proximal hole to reduce the dorsal tilt by positioning the plate on the shaft. The small defect on the dorsal cortex of the osteotomy site was filled with the surrounding soft callus chips. The pronator quadratus muscle was reattached by absorbable sutures. The osteotomy site was immobilized in a below-elbow volar plaster splint for 2 weeks postoperatively. Physiotherapy to maintain the wrist motion was initiated immediately after splint removal.

Results

Radiological Findings

Results pertaining to changes in dorsal tilting, radial inclination, and ulnar variance as determined by radiograph examination 4.5 months postoperatively are presented in Table . All fractures were united with dorsal cortical bridging (as evaluated at the dorsal cortex) by 12 weeks postoperatively. Dorsal tilt improved from a preoperative average of 20.7° to a postoperative average of 0°. Radial inclination improved from an average of 13.6° to 18.7° (normal range, 18°–22°). Ulnar variance improved from an average of 1.4 to 0.4 mm (normal length, 0 mm). At 3 months postoperatively, mean decreases of 1.3° and 1.0° were evident for palmar tilt and radial inclination, respectively. Mean ulnar variance was 0.2 mm at this time. The main loss of reduction occurred within the first 6 weeks postoperatively. There were no cases of implant failure, screw loosening, or tendon rupture or adhesion. No further changes were apparent between 4.5- and 12-month follow-up.

Clinical Outcomes

Mean flexion/extension and supination/pronation angles for surgically repaired wrists are shown in Table . The angles increased with time following surgery. The grip strength of the operated hand was an average of 90% of that in the contralateral hand by 6 months postoperatively. The Mayo Wrist Scores were excellent in all patients at 4.5-month follow-up (Table ). No further changes were apparent between 4.5- and 12-month follow-up.

Clinical Evaluation of Wrist Active ROM and Mayo Wrist Score to Assess General Wrist Function and Pain Level Postoperatively

Table 2. Clinical Evaluation of Wrist Active ROM and Mayo Wrist Score to Assess General Wrist Function and Pain Level Postoperatively

Radiographs for 2 patients are presented in Figures and . Patient 1 presented with an AO type C1 fracture after 8 weeks of wrist immobilization. Stiffness of the wrist joint was apparent after short-arm cast immobilization for 6 weeks. Radiographs revealed 30° dorsal tilt, 8° radial inclination, and 2.0-mm radial shortening (Figure ).

A 61-Year-Old Woman Sustained a Right Wrist Injury Following a Fall. Initially, the Patient Opted for Nonoperative Treatment in the Form of Short-Arm Splint Immobilization for 5 Weeks. Following This, Radiographs Revealed a Distal Radial Fracture (AO Type C1) with Dorsal Titling of Approximately 18° and Radial Shortening (A, B). Osteotomy Was Performed Along the Previous Fracture Site (B, Red Line) and Fixation Was Achieved Using a Palmar Locking Plate (C, D). Postoperatively, Palmar Tilt Was 0°, Radial Inclination Was 20°, and Ulnar Variance Was No Longer Evident. Clinical Improvement of Flexion/extension Was Observed 3 Months Postoperatively (E, F).

Figure 1:. A 61-Year-Old Woman Sustained a Right Wrist Injury Following a Fall. Initially, the Patient Opted for Nonoperative Treatment in the Form of Short-Arm Splint Immobilization for 5 Weeks. Following This, Radiographs Revealed a Distal Radial Fracture (AO Type C1) with Dorsal Titling of Approximately 18° and Radial Shortening (A, B). Osteotomy Was Performed Along the Previous Fracture Site (B, Red Line) and Fixation Was Achieved Using a Palmar Locking Plate (C, D). Postoperatively, Palmar Tilt Was 0°, Radial Inclination Was 20°, and Ulnar Variance Was No Longer Evident. Clinical Improvement of Flexion/extension Was Observed 3 Months Postoperatively (E, F).

A 43-Year-Old Woman Sustained a Right Wrist Injury as a Result of a Traffic Accident. Initially, the Patient Opted for Nonoperative Treatment in the Form of Short-Arm Splint Immobilization for 8 Weeks. Subsequent Radiographs Revealed a Distal Radial Fracture (AO Type A3) with a Radial Inclination of 8° and a Dorsal Tilt of Approximately 30° (A, B). Osteotomy Was Performed Along the Previous Fracture Site (B, Red Line), and Fixation Was Achieved Using a Palmar Locking Plate (C, D). Postoperatively, Dorsal Tilt Was 3°, Radial Inclination Was 12°, and Radial Shortening Was 1 mm. Clinical Improvement of Flexion/extension Was Observed at 4.5 Months Postoperatively (E, F).

Figure 2:. A 43-Year-Old Woman Sustained a Right Wrist Injury as a Result of a Traffic Accident. Initially, the Patient Opted for Nonoperative Treatment in the Form of Short-Arm Splint Immobilization for 8 Weeks. Subsequent Radiographs Revealed a Distal Radial Fracture (AO Type A3) with a Radial Inclination of 8° and a Dorsal Tilt of Approximately 30° (A, B). Osteotomy Was Performed Along the Previous Fracture Site (B, Red Line), and Fixation Was Achieved Using a Palmar Locking Plate (C, D). Postoperatively, Dorsal Tilt Was 3°, Radial Inclination Was 12°, and Radial Shortening Was 1 mm. Clinical Improvement of Flexion/extension Was Observed at 4.5 Months Postoperatively (E, F).

Discussion

We performed delayed corrective osteotomies to repair dorsally tilted distal radial fractures with latent malunion. Osteotomies were fixed using palmar locking plates without supportive structural corticocancellous bone (or bone substitute) grafting. The small dorsal cortical defects at the osteotomy sites were filled with newly formed incipient healing callus. With common fractures, soft callus gradually forms approximately 2 to 4 weeks postinjury. By 4 to 8 weeks, calcification begins, and after 8 weeks the soft callus consolidates with fracture union in distal radius. Therefore, the soft callus that forms underneath the fracture site can be used to fill the chipped/damaged area of the fracture in patients who have delayed treatment from between 4 and 8 weeks. In the past, we often found loss of reduction using conventional T-plates on the volar cortex without structural bone grafting at dorsal site. To avoid loss of reduction, long-term short-arm casting, dorsal buttress plate, or structural bone grafting were applied. This study indicated that using palmar locking plate without structural bone graft and short-term casting is a simple and effective treatment. In addition to anatomical reduction, early bone union and excellent wrist ROM were achieved after early rehabilitation in all patients.

There are several reasons why only patients with AO types A2, A3, and C1 were included in this study. The pain associated with these fracture types is not severe, and as such they are susceptible to be neglected or treated by nonoperative means. In contrast, individuals suffering AO type C2 and C3 fractures tend to experience severe pain and swelling on injury and seek immediate medical attention. Hence, these fracture types (which are also more complex) are more likely to be surgically repaired within a short time after injury. Individuals with A2, A3, and C1 type non-displaced fractures may not seek medical attention until the wrist starts to deform, typically 4 to 6 weeks after injury. At this point, traditional surgical repair techniques necessitate bone grafting. In addition, the articular surfaces in patients with type A2, A3, and C1 fractures are generally intact and in comparatively good condition when compared to AO type C2 and C3 fractures. This facilitates ease of surgical repair (typically only correction of axial alignment is warranted).

One patient described in this series was treated 8 weeks after initial injury. In previous cases (not presented here), we found that correction using a dorsal minimal approach is difficult when treatment is delayed for >8 weeks. In such cases, extensive periosteum and soft tissue dissection is necessary to achieve anatomic reduction, and bone grafting is required (due to the lack of soft callus) to fill the damaged fracture area. Our patient was a young woman who expressed concern over additional scarring, so we attempted correction without bone grafting. Although complete anatomic reduction was not achieved, the palmar locking plates offered sufficient support to prevent dorsal angulation of distal fragment. At 4.5-month follow-up, this patient exhibited an excellent Mayo Wrist Score and markedly improved wrist joint active ROM. Given these findings, the method used in this study is appropriate when treatment is delayed for a maximum of 8 weeks. After 8 weeks, when the calluses have calcified and hardened, extensive dissection with bone grafting is warranted.

Some surgeons have reported that use of a 2-plate technique though a dorsal approach with double AO 2.4-mm dorsal locking plates can prevent dorsal tilt without requiring the removal Lister’s tubercle. This technique is also associated with decreased tendon and soft tissue irritation. However, autologous bone grafting was required to fill the bony defect at the osteotomy site. In addition, the periosteum of the dorsal cortex was inevitably extensively stripped through the dorsal approach with dorsal double plating resulting in delayed union. We found that use of palmar locking plates without bone grafting facilitated solid bony union and was not associated with irritation of flexor or extensor tendons in any case. The fact that there was no delay in bony union (compared to previous reports/methods) is an important point. This is likely due to the limited periosteum dissection required. While the described 2-plate technique involves a dorsal approach only (and hence a single incision), extensive periosteum and soft tissue dissection, and inevitably bone grafting (requiring an additional incision), are necessary. We believe that the palmar locking plate technique used in this report is superior to the 2-plate technique due to the lack of a requirement for bone grafting from other donor sites and decreased morbidity.

Conclusion

We have reported a series of cases in which delayed dorsally angulated distal radial fractures (AO types A2, A3, and C1) with latent malunion, articular congruity, and axial alignment were repaired using a double approach. The palmar locking plates provided sufficient stability for corrective osteotomy within 8 weeks of injury without the need of structural bone grafting. The easily contoured locking plates facilitated avoidance of flexor and extensor tendon irritation. Furthermore, the minimal dorsal approached results in limited periosteum and soft tissue dissection and hastens bony union. Casting immobilization was not necessary and a good wrist ROM was restored early after rehabilitation. The described approach may be efficacious for individuals requiring delayed repair (up to 8 weeks after injury) of distal radial fractures with latent malunion and dorsal tilt. We also suggest that use of palmar locking plates using the same approach may be efficacious in older individuals with osteoporotic bone, in whom bone grafting is problematic. Furthermore, given the straightforward nature of the procedure, regional anesthesia could be used in future similar cases to reduce the risk of general anesthesia-associated complications (particularly in elderly patients).

References

  1. 1. Fernandez DL. Correction of post-traumatic wrist deformity in adults by osteotomy, bone-grafting, and internal fixation. J Bone Joint Surg Am. 1982; 64(8):1164–1178.
  2. 2. Adams BD. Effects of radial deformity on distal radioulnar joint mechanics. J Hand Surg Am. 1993; 18(3):492–498. doi: 10.1016/0363-5023(93)90098-N [CrossRef]
  3. 3. Jupiter JB, Masem M. Reconstruction of post-traumatic deformity of the distal radius and ulna. Hand Clin. 1988; 4(3):377–390.
  4. 4. Amadio PC, Botte MJ. Treatment of mal-union of the distal radius. Hand Clin. 1987; 3(4):541–561.
  5. 5. Lubahn JD, Hood JM, Nechleba J, Williams DP, Green T. Gradual reduction of distal radial malunion using distraction osteogenesis. J Hand Surg Am. 2007; 32(6):795–800. doi: 10.1016/j.jhsa.2007.04.009 [CrossRef]
  6. 6. Shea K, Fernandez DL, Jupiter JB, Martin CJr. Corrective osteotomy for malunited, volarly displaced fractures of the distal end of the radius. J Bone Joint Surg Am. 1997; 79(12):1816–1826.
  7. 7. Posner MA, Ambrose L. Malunited Colles’ fractures: correction with a biplanar closing wedge osteotomy. J Hand Surg Am. 1991; 16(6):1017–1026. doi: 10.1016/S0363-5023(10)80061-9 [CrossRef]
  8. 8. Ladd AL, Huene DS. Reconstructive osteotomy for malunion of the distal radius. Clin Orthop Relat Res. 1996; (327):158–171. doi: 10.1097/00003086-199606000-00021 [CrossRef]
  9. 9. Nana AD, Joshi A, Lichtman DM. Plating of the distal radius. J Am Acad Orthop Surg. 2005; 13(3):159–171.
  10. 10. Ring D, Roberge C, Morgan T, Jupiter JB. Osteotomy for malunited fractures of the distal radius: a comparison of structural and nonstructural autogenous bone grafts. J Hand Surg Am. 2002; 27(2):216–222. doi: 10.1053/jhsu.2002.32076 [CrossRef]
  11. 11. Jakob M, Rikli DA, Regazzoni P. Fractures of the distal radius treated by internal fixation and early function. A prospective study of 73 consecutive patients. J Bone Joint Surg Br. 2000; 82(3):340–344. doi: 10.1302/0301-620X.82B3.10099 [CrossRef]
  12. 12. Trumble TE, Culp RW, Hanel DP, Geissler WB, Berger RA. Intra-articular fractures of the distal aspect of the radius. Instr Course Lect. 1999; (48):465–480.
  13. 13. Carter PR, Frederick HA, Laseter GF. Open reduction and internal fixation of unstable distal radius fractures with a low-profile plate: a multicenter study of 73 fractures. J Hand Surg Am. 1998; 23(2):300–307. doi: 10.1016/S0363-5023(98)80131-7 [CrossRef]
  14. 14. Arora R, Lutz M, Fritz D, Zimmermann R, Oberladstätter J, Gabl M. Palmar locking plate for treatment of unstable dorsal dislocated distal radius fractures [published online ahead of print May 13, 2005]. Arch Orthop Trauma Surg. 2005; 125(6):399–404. doi: 10.1007/s00402-005-0820-8 [CrossRef]
  15. 15. Chung KC, Watt AJ, Kotsis SV, Margaliot Z, Haase SC, Kim HM. Treatment of unstable distal radial fractures with the volar locking plating system. J Bone Joint Surg Am. 2006; 88(12):2687–2694. doi: 10.2106/JBJS.E.01298 [CrossRef]
  16. 16. Rozental TD, Blazar PE. Functional outcome and complications after volar plating for dorsally displaced, unstable fractures of the distal radius. J Hand Surg Am. 2006; 31(3):359–365. doi: 10.1016/j.jhsa.2005.10.010 [CrossRef]
  17. 17. Musgrave DS, Idler RS. Volar fixation of dorsally displaced distal radius fractures using the 2.4-mm locking compression plates. J Hand Surg Am. 2005; 30(4):743–749. doi: 10.1016/j.jhsa.2005.03.006 [CrossRef]
  18. 18. Wright TW, Horodyski M, Smith DW. Functional outcome of unstable distal radius fractures: ORIF with a volar fixed-angle tine plate versus external fixation. J Hand Surg Am. 2005; 30(2):289–299. doi: 10.1016/j.jhsa.2004.11.014 [CrossRef]

Summary of Data

Patient No./Sex/Age, y Delay, wk AO Classification Dorsal Tilting, deg
Radial Inclination, deg
Ulnar Variance, mm
Pre Post a Pre Post a Pre Post a
1/F/68 b 5 A2 25 -2 c 11 20 0.0 0.0
2/F/61 d 5 C1 18 0 20 20 1.0 1.0
3/M/76 d 7 C1 15 -2 14 19 1.0 0.0
4/F/56 b 6 A2 22 0 14 20 0.0 0.0
5/F/43 d 8 A3 30 3 8 12 2.0 1.0
6/M/52 b 6 A2 20 0 15 19 0.0 0.0
7/M/34 d 7 A3 15 1 13 20 3.0 1.0

Clinical Evaluation of Wrist Active ROM and Mayo Wrist Score to Assess General Wrist Function and Pain Level Postoperatively

Patient No. 6 Wk
3 Mo
4.5 Mo
Flex/Ext a Sup/Pro a Mayo Score Flex/Ext Sup/Pro Mayo Score Flex/Ext Sup/Pro Mayo Score
1 60/70 70/80 80 80/85 80/85 90 85/90 90/90 100
2 45/60 60/70 65 60/70 75/85 75 75/80 80/90 90
3 50/65 65/70 65 60/70 70/80 75 70/80 75/80 90
4 55/60 60/70 60 70/80 80/85 85 80/85 80/90 90
5 30/50 55/60 55 65/75 75/80 70 80/85 85/90 95
6 50/60 60/70 65 65/75 75/80 80 80/85 80/90 90
7 50/55 60/70 60 70/75 80/85 90 80/85 80/90 95

10.3928/01477447-20110427-12

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