OTA 2004 Posters
A Prospective Multicenter Study of New, Fragment-Specific, Locking Implants for Treatment of Distal Radius Fractures
Purpose: Concepts regarding treatment of fractures of the distal radius have changed considerably in the past decade. A greater appreciation of distal radius fracture patterns has led to the realization that many complex fractures can be operatively secured with smaller strategically placed fragment-specific implants. We report on the outcome of a consecutive series of 100 patients treated with a newly designed modular set of 2.4 implants. They were designed on the basis of the biomechanical three-column concept and shaped to fit specific aspects of the radius. The implants incorporate "locked" screws to enhance fixation in osteoporotic bone. Anatomically shaped volar plates permit fixation of both dorsally and volarly displaced fractures.
Methods: A prospective multicenter case-controlled study involving five centers was initiated in August 2001; 55 female and 45 male patients with an average age of 52 years (range, 17 to 86) were enrolled. Fractures were classified by the AO/ASIF method and included 36 C3, 22 C2, 13 C1, 15 B3, 2 B2, 1 B1, 10 A3, and 1 A2 fractures. Of these, 55 were treated from a volar approach, including those requiring standard buttress plating as well as dorsally displaced Colles' type with specially designed contoured locking plates. Thirty-nine fractures, including fracture-dislocations and those associated with carpal ligament injury were approached from the dorsal side with fragment-specific dorsal and radial column plates, and 6 with combined fixations. Associated lesions were found in 11 patients. The patients were all mobilized within 7 to 10 days except for those with intercarpal ligament injury.
Results: At an average follow-up of 15 months, all fractures healed without evidence of plate loosening, breakage, or loss of reduction. Scores of the DASH and SF-36 questionnaires improved significantly from preoperative levels. There have been no tendon ruptures, and plate removal has been done in only six patients. Radiographically, no arthrosis was seen in 90 patients, and grade 1 was seen in 10. Complications included four patients who had loss of palmar tilt and settling of the fracture due to a large metaphyseal defect in the dorsal cortex treated with a palmar plate for a dorsally displaced fracture. None of the locking screws were noted to have displaced in these four patients.
Conclusions: On the basis of the concept of fragment-specific fixation as well as a palmar approach when applicable for dorsally displaced fractures, these newly designed implants featuring low profile, anatomic contour, and locking screws have resulted in a consistent outcome following operative fixation even in difficult fracture patterns or those complicated by advanced osteoporosis.