Comparison of locking anatomic volar plate fixation and external fixation in the treatment of AO type C radius distal-end fractures

• Main Authors: Kenan Guvenc, Serdar Toker, Uygar Kiran, Faik Ilik
• Format: Article
• Language: English
• Published: SAGEYA Publishing Company 2017-04-01
• Series: Hand and Microsurgery
• Subjects: Distal radius; volar plating; external fixation
• Online Access: http://www.ejmanager.com/fulltextpdf.php?mno=220534

Objective: The goal here was to compare the results of locking anatomic palmar plate fixation and external fixation with K-wire augmentation in AO Type C radius distal-end fractures. Study Design: Open reduction and palmar locking anatomic plate fixation was applied to 36 patients (Group 1) who underwent surgery based on AO Type C radius lower-end fracture and closed reduction while external fixation with K-wire augmentation was applied to another group of 36 patients of the same type (Group 2). Joint ranges of motion and grip strength of the patients were measured for functional evaluation. Clinical assessments were made by determination with the Gartland-Werley scale, Green and O&#146;Brien clinical scoring and DASH scoring. Radiological measurements were made according to Stewart&#146;s radiological assessment, and arthritic changes were established based on arthritic radiological grading specified by Knirk and Jupiter. Results: In Group 1, wrist flexion, extension, and degree of radial and ulnar deviation at final follow-up were significantly higher compared to Group 2 (p <0.05). When both groups were compared statistically, a significant difference was found in favor of Group 1 in terms of postoperative volar tilt (p = 0.001). Stewart&#146;s radiological assessment revealed a significant difference also weighted toward Group 1 (p = 0.015). Further, a significant difference was identified in Group 1 with respect to clinical results based on Green and O&#146;Brien clinical scoring of the treatment groups (p <0.05). No statistically significant difference was observed between the clinical results based on DASH scoring of the treatment groups (p <0.05). Compared to the normal side, average hand grip strength of Group 2 patients was 62.3% (41-98), while that of Group 1 was 70.9% (27-97). There was no statistical difference between the groups in terms of grip strength (p = 0.732), nor was there a statistically significant difference identified between the treatment groups according to Knirk and Jupiter&#146;s arthritis grading (p = 0.119). There were no complications in Group 1, whereas a superficial pin-wire tract infection was observed in one patient in Group 2. Conclusion: Better functional and clinical results were obtained for patients with complex fractures associated with joint of radius distal-end fractures compared with the group treated with an external fixator. At further stages, there was no difference in terms of arthritic changes between the two fixation methods. This result shows that according to AO classification, in the case of type C radius distal-end fractures, except for very distal fractures not amenable to plate fixation, locked volar plating provides a safe and stable fixation and hence why it is the preferred method. [Hand Microsurg 2017; 6(1.000): 15-20]