Volar locking plate (VLP) versus non-locking plate (NLP) in the treatment of die-punch fractures of the distal radius, an observational study. (October 2016)

• Record Type: Journal Article
• Authors: Zhang, Xiong; Hu, Chunhe; Yu, Kunlun; Bai, Jiangbo; Tian, Dehu; Xu, Yi; Zhang, Bing
• Is Part Of: International journal of surgery. Volume 34(2016)
• Page Start: 142
• Page End: 147
• Publication Date: 2016-10
• Subjects: Die-punch fracture -- Distal radius -- Volar locking plate -- Non-locking plate; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; 617.005
• DOI: 10.1016/j.ijsu.2016.08.527
• Languages: English
• ISSNs: 1743-9191

Abstract

Abstract: Purpose: This study aims to evaluate whether volar locking plate was superior over non-locking plate in the treatment of die-punch fractures of the distal radius. Methods: A total of 57 patients with closed die-punch fractures of the distal radius were included and analyzed. Of them, 32 were treated by non-locking plate (NLP) and the remaining 25 were treated by volar locking plate (VLP). Preoperative radiographs, computer tomographs and three-dimensional reconstruction, radiographs taken at immediate postoperation and at last follow-up were extracted and evaluated. Patients' electronic medical records were inquired and related demographic and medical data were documented. The documented contents were volar tilt, radial inclination, ulnar variance, grip strength, Disabilities of the Arm, Shoulder, and Hand (DASH) and visual analog scale (VAS) scores and complications. Results: VLP group demonstrated a significantly reduced radial subsidence of 1.5 mm (0.7 versus 2.2 mm), during the interval of bony union (P < 0.001), compared to NLP group. Larger proportion of patients (88% versus 62.5%) in VLP group gained acceptable joint congruity (step-off <2 mm) at the final follow-up (P = 0.037). No significant differences were observed between the groups in the measurements of volar tilt, radial inclination, DASH, VAS and grip strength recovery at the last follow-up. There was a trend of fewer overall complications (5/25 versus 10/32) and major complications that required surgery interventions (1/25 versus 4/32) in VLP than NLP groups, although the difference did not approach to significance (P = 0.339, 0.372). Conclusions: VLP leaded to significantly better results of reduction maintainance and the final joint congruity than NLP, while reducing overall and major complications. However, the results should be treated in the context of limitations and the clinical significance of the difference required further studies to investigate. Highlights: Preoperative CT and reconstruction is essential to diagnose Die-punch fractures of distal radius. VLP could better maintain the reduction after operation than NLP. Patients treated by VLP or NLP could obtain similar functional outcomes at the follow-up>1 year.