Relationship Between Complications and the Learning Curve of Volar Plate Fixation Technique for Distal Radius Fractures

Objective: The study was designed to analyse the relationship between complications and the learning curve of volar plate fixation technique for distal radius fractures. Methods: Fifty adult patients (30 men, 20 women, average age 44.5, range; 18-75) with isolated distal radius fractures who had been treated by volar placed plate fixation have been retrospectively evaluated. Patients were divided into two groups as; between 2005-2007 years (Group A; nA=25) and 2007-2009 years (Group A; nA=25). The average age of patients in Group A was 43.5 (range; 18-75), 17 men and 8 women. The range of fractures were assessed according to the classification of AO/ASIF as; 13 (52%) Type C; 8 (32%) Type B; 4 (16%) Type A. The average age of patients in Group B was 45 (range; 20-66), 13 men and 12 women. The types of fractures in this group were; 19 (76%) Type C; 4 (16%) Type B; 2 (8%) Type A. The total surgery and scopy time of patients were recorded. Radiological and functional results and problems acquired from early and late observations after the surgery were recorded. Data gained from objective and subjective evaluation criteria were compared. Results: The average follow-up was 22 months. As a result of the evaluations made by Student t test, no difference were found between two groups according to the age, sex and fracture type. The total surgery and radioscopy times of Group A were much longer. At early follow-up, the patient (n=1) in Group A with an ntra-articular screw was revised. The patient (n=1) in Group B with ulnar nerve neuropraxia was observed. During the screwing of the plate in Group A 8 patients, in Group B 3 patients were re-operated with unsuitable screw lengths. In one patient in both groups, an improper locking technique of one or more distal screws to the plate were determined. In 5 patients in Group A, and 2 patients in Group B, placement of the plates were eccenteric. All fractures were within a 7 week-period. In the late term follow-up; 3 patients in Group A with stage I, 2 patients with stage II arthrosis and one patient in Group B with stage II arthrosis were seen. None of the patients had radiocarpal collapse at late term controls. 7 patients in Group A and 2 patients in Group B had swelling and stinging sensation in the volar/dorsal side in routine daily activities. 4 patients in Group A and 1 patient in Group B had tenosynovitis, due to irritation of the soft tissue by extracting the fixation materials. Conclusion: Volar plate fixation technique which is used frequently for distal radius fractures, requires a learning curve depending on the knowledge and experience of a single trauma surgeon. Not to be used by the surgical technique of volar locked plate meticulously, variable problems can occur at mid-term and late-term and also secondary operations can be required.