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  • Title: [Comparison between volar and dorsal plate positions in the treatment of unstable fracture of distal radius].
    Author: Huang J.
    Journal: Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi; 2008 Aug; 22(8):948-51. PubMed ID: 18773811.
    Abstract:
    OBJECTIVE: To compare the differences between volar and dorsal plate positions in the treatment of unstable fracture of distal radius. METHODS: From June 2000 to December 2006, 61 cases with fracture of distal radius were treated, 27 males and 34 females aged 22-70 years (55.5 years on average), among which 18 cases were caused by traffic accidents and 43 cases falls. All cases were fresh closed fractures. All patients had AP and lateral X-ray films of the wrist preoperatively and 30 cases experienced CT scan. According to AO, there were 25 cases for B1, 18 for B2, 7 for B3, 7 for C1, and 4 for C2. All the cases were randomized into 2 groups: the wrist palmar group (group A, n=34) and dorsal group (group B, n=27), to perform volar and dorsal plate fixation, respectively. As to the measurement of fortune for the preoperative ruler and inclination angle, group A were (-45.0 +/- 53.0)degrees and (8.6 +/- 3.1)degrees, respectively, and group B were (-40.0 +/- 30.0)degrees and (7.3 +/- 5.6)degrees, respectively. Preoperative radial shortened (12.0 +/- 5.3) mm in group A, and (10.3 +/- 4.2) mm in group B. Joint surface level was (4.3 +/- 2.2) mm in group A, and (4.1 +/- 3.3) mm in group B. RESULTS: All of the 61 cases were followed up for 6-27 months (16 months on average). All the fractures were healed, the time to healing in group A was (8.2 +/- 1.6) weeks, and in group B was (8.1 +/- 1.2) weeks, and the difference was not significant (P > 0.05). As for the wrist function by Gartland-Werley scoring at the 8th week after operation, 7 cases were excellent, 10 good, and 17 poor in group A with the choiceness rate of 50.0%, while 7 cases were excellent, 11 good and 9 poor in group B with the choiceness rate of 66.7%. There was significant difference between the two groups (P < 0.01). And at the 24th week after operation, 21 cases were excellent, 9 good, and 4 poor in group A with the choiceness rate of 88.2%, while 18 cases were excellent, 5 good, and 4 poor in group B with the choiceness rate of 85.2%. There was no significant difference between the two groups (P > 0.05). As for radiological assessment by Sarmiento, device and palm inclination angles in group A were (9.5 +/- 3.1)degrees and (18.0 +/- 8.2)degrees, respectively, and in group B were (11.0 +/- 4.7)degrees and (16.0 +/- 7.6)degrees, respectively. No radial shortening was found either in group A or in group B, and joint surface level in both groups were less than 1 mm. There was no significant difference between group A and group B in terms of all indicators postoperatively (P > 0.05), but there was significant difference when compared with preoperation (P < 0.001). With regard to comparison of postoperative complications between the two groups, there was no significant difference (P > 0.05) in early postoperative complications, but there was in long-term complications (P < 0.01). CONCLUSION: The volar and dorsal plate positions may offer effective stability for unstable distal radial fracture and early functional exercise. The volar plate position may influence the pronation function of the wrist joint in the short run, while the dorsal plate position may cause more complications in the long run.
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