An Advanced Study on Volar Locking Plate as a Surgical Procedure for Distal Radius Fracture

DRF (distal radius fractures) are the most prevalent type of upper extremity fracture, accounting for 44 percent of all forearm and hand fractures. The goal of surgical treatment for unstable DRF is to restore wrist function. There are proponents in literature suggesting that volar locking plates are the most optional surgical methods in treatment of these fractures. The aim of this study is to answer the question: Is the volar locking plate the only surgical method treating all types of distal radius fractures and decreasing the rate of postsurgical complication?

Materials & Methods: 104 fractures in 98 patients with an average age of 48,5 years were treated with a volar locking plate for unstable distal radius fractures. All fractures classified by AO/OTA in A2-3 27 cases, B1-3 in 45 and C1-3 in 32 cases. Most patients operated within 48-72 hours after injury. A volar locking device was used in all DRFs and an extended flexor carpi radialis approach was used in all cases. Low profile locking plates were employed in sixteen cases with base of ulnar styloid fractures, whereas Kirschner wires were used in the other patients. Postoperatively, all patients completed a typical rehabilitation regimen that included passive and active finger and wrist mobility. Results: Complications, time to fracture union, range of motion, Visual Analogue Scale, Quick Dash Score, and Patients-Rated Wrist Evaluation score were all taken into consideration when evaluating patients. Patients under 60 years old with type A2-3 and B1-3 fractures had a superior range of motion and grip strength than those over 65. When comparison to the unilateral side, ROM and grip strength reduced in subjects with type fractures C1-3 and age over 65.In comparison to the other two types of fractures, the percentage of complications and reoperation looked to be higher in type C1-3. Finally, the rates of Quick-DASH, PRWE and range of motion were better in type A, B and C1 than type C2-3, compared with uninjured hand.

Conclusion: In recent years, unstable fractures required surgery treatment, with the volar locking plate serving as the gold standard. Unfortunately, VPL has postoperative difficulties linked to plate and screw position with comminuted fracture or soft tissue injury that cannot be overlooked, and it may be insufficient for all forms of distal radius fractures for these reasons.