Volar locking plating for distal radial fractures

The purpose of this prospective study was to compare the functional and radiological results and complication rates after locking plate osteosynthesis of unstable distal radial fractures in elderly patients as a function of the bone mineral density (BMD). The hypothesis that reduced BMD is accompanied by poorer function and a higher rate of complications was investigated. A total of 65 consecutive patients with unstable distal radial fractures, AO 23-A2 (n=1), -A3 (n=29), -C1 (n=2), -C2 (n=28) and -C3 (n=5) were included with a mean age of 69 years (range, 52-86 years). Standardized clinical and radiological follow-up was performed 6 weeks, 3 and 12 months postoperatively. All patients underwent dual x-ray absorptiometry of the contralateral distal radius within 6 weeks postoperatively and 3 groups could be differentiated: group I (n=27) osteoporosis, group II (n=27) osteopenia and group III (n=11) normal BMD. Data on the DASH and QAL scores as well as the range of motion, grip strength and radiological parameters were collected. According to the BMD a detailed analysis of complications was performed. Exemplary the 12 months results of DASH and the range of motion are shown here: the DASH 12 months postoperatively was DASH(total)=6 (0-64) P, DASH(group I)=7 (0-32.5) P, DASH(group II)=11 (1-63) P, DASH(group III)=2 (0-23) P, no significance. The range of motion increased significantly in all 3 groups (except pronation in groups I and III) from 6 weeks to 3 and 12 months postoperatively and 12 months postoperatively showed means for dorsal extension 55A degrees (25-75), palmar flexion 55A degrees (35-75), ulnar abduction 35A degrees (20-45), radial abduction 20A degrees (5-40), supination 90A degrees (60-90) and pronation 85A degrees (65-90) in the total sample. The comparison of DASH and range of motion was not significantly different at each time of follow-up between all 3 groups. A group-specific analysis of implant and BMD dependent complications showed 2/27 (7%) secondary intra-articular screw perforations in group I, 1/27 (4%) in group II and 0/11 in group III. The hypothesis that a reduced BMD is accompanied by a poorer function and a higher rate of complications was refuted. Analysis of complications showed a trend to more BMD-dependent complications in the osteoporosis group.