Distal Radius Fractures in the Elderly: Use of the Volar Bearing Plate

• Published in: Annals of plastic surgery Vol. 82; no. 1; pp. 34 - 38
• Main Authors: Miller, Jonathan E, Naram, Aparajit, Qin, BaiJing, Rothkopf, Douglas M
• Format: Journal Article
• Language: English
• Published: United States Copyright Wolters Kluwer Health, Inc. All rights reserved 01-01-2019
• Subjects: Aged; Aged, 80 and over; Bone Plates; Cohort Studies; Female; Follow-Up Studies; Fracture Fixation, Internal - instrumentation; Fracture Fixation, Internal - methods; Fracture Healing - physiology; Geriatric Assessment; Hand Strength - physiology; Humans; Injury Severity Score; Length of Stay; Male; Open Fracture Reduction - methods; Radius Fractures - diagnostic imaging; Radius Fractures - surgery; Range of Motion, Articular; Retrospective Studies; Wrist Injuries - diagnostic imaging; Wrist Injuries - surgery
• ISSN: 0148-7043; 1536-3708
• DOI: 10.1097/SAP.0000000000001653

BACKGROUNDDistal radius fractures represent some of the most common injuries to the upper extremity, yet current evidence demonstrates great variability in the management of this injury. Elderly patients, in particular, stand to benefit from the early mobilization provided by operative fixation with a volar bearing plate.
METHODSWe conducted a retrospective chart review on all patients 65 years or older who underwent unilateral open reduction internal fixation of distal radius fractures using a volar bearing plate at a single institution between January 2014 and January 2016. We excluded patients with bilateral injuries, multiple fractures, and major injuries to the same extremity.
RESULTSFifty-five patients met criteria for this study. By AO classification, we repaired 17 type A, 24 type B, and 14 type C fractures. At final radiographic measurements, average radial height compared with ulna measured −0.31 mm, average radial inclination measured 20.45 degrees, and average volar tilt measured 7.11 degrees. On discharge, 36 patients had wrist range-of-motion data consistent with a functional wrist. Four patients had limitations in the flexion/extension plane, 8 with radial-ulnar deviation, and 7 had limitations in both planes.
CONCLUSIONSDistal radius fractures in the elderly may successfully be treated with a volar bearing plate. Useful strategies include supraperiosteal dissection of the radius from the pronator quadratus, use of a longer plate for stronger proximal fixation in osteoporotic bone, and regional block. This methodology allows for a safe procedure facilitating the early return of hand and wrist function.