International Orthopaedics

, Volume 42, Issue 9, pp 2243–2248 | Cite as

Prospective study of comminuted articular distal radius fractures stabilized by volar plating in the elderly

  • Daniel Martinez-Mendez
  • Alejandro Lizaur-UtrillaEmail author
  • Joaquin de Juan-Herrero
Original Paper



The objective was to assess the ability of the volar locking plate to maintain the radiographic parameters over the time in elderly patients with complex intra-articular distal radius fractures.


Prospective cohort of 66 consecutive patients with mean age of 68 (range 60–81) years and AO type C fractures treated with volar locking plate. Radiographic measurements were performed pre and post-operatively at each follow-up. Clinical assessment was made by Patient-Rated Wrist Evaluation scores, Disabilities of the Arm, Shoulder and Hand score, range of motion, and grip strength.


The mean post-operative follow-up was 31 (range, 24–47) months. The most difficult parameters to restore intra-operatively were volar tilt and radial height, while radial inclination and ulnar variance were restored in a high rate of patients. There was significant loss of reduction within four post-operative months in volar tilt (p = 0.001) and radial height (p = 0.029). Mean radiographic parameters had no changes from four months to final evaluation. At final follow-up, 50.1% of the patients had all radiographic parameters restored in comparison with the noninvolved wrist, but 83.3% had all radiographic parameters within a functional range (p = 0.001). No significant relationship between radiographic and functional outcomes was found (p = 0.474).


This study found that volar locking plate fixation for displaced intra-articular distal radius fractures in elderly patients was an effective procedure to obtain success functional outcomes. Although reduction loss in volar tilt and radial height occurred within four first months, volar plate was able to maintain fracture stabilization with radiographic parameters within functional range over the time in most patients of these elderly patients.


Distal radius fracture Intra-articular fracture Elderly Surgical treatment Volar locking plate Radiographic outcome 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Schmelzer-Schmied N, Wieloch P, Martini AK, Daecke W (2009) Comparison of external fixation, locking and non-locking palmar plating for unstable distal radius fractures in the elderly. Int Orthop 33:773–778. CrossRefPubMedGoogle Scholar
  2. 2.
    Catalano LW 3rd, Cole RJ, Gelberman RH, Evanoff BA, Gilula LA, Borrelli J Jr (1997) Displaced intra-articular fractures of the distal aspect of the radius: long-term results in young adults after open reduction and internal fixation. J Bone Joint Surg Am 79:1290–1302CrossRefPubMedGoogle Scholar
  3. 3.
    Chou YC, Chen AC, Chen CY, Hsu YH, Wu CC (2011) Dorsal and volar 2.4-mm titanium locking plate fixation for AO type C3 dorsally comminuted distal radius fractures. J Hand Surg Am 36:974–981. CrossRefPubMedGoogle Scholar
  4. 4.
    Goldfarb CA, Rudzki JR, Catalano LW, Hughes M, Jr BJ (2006) Fifteen-year outcome of displaced intra-articular fractures of the distal radius. J Hand Surg Am 31:633–639. CrossRefPubMedGoogle Scholar
  5. 5.
    Perugia D, Gizzini M, Civitenga C, Guidi M, Dominido C, Fontana D, Ferretti A (2014) Is it really necessary to restore radial anatomic parameters after distal radius fractures? Injury 45(Suppl 6):S21–S26. CrossRefGoogle Scholar
  6. 6.
    Synn AJ, Makhni EC, Makhni MC, Rozental TD, Day CS (2009) Distal radius fractures in older patients: is anatomic reduction necessary? Clin Orthop Relat Res 467:1612–1620. CrossRefPubMedGoogle Scholar
  7. 7.
    Trumble TE, Schmitt SR, Vedder NB (1994) Factors affecting functional outcome of displaced intra-articular distal radius fractures. J Hand Surg Am 19:325–340. CrossRefPubMedGoogle Scholar
  8. 8.
    Mignemi ME, Byram IR, Wolfe CC, Fan KH, Koehler EA, Block JJ, Jordanov MI, Watson JT, Weikert DR, Lee DH (2013) Radiographic outcomes of volar locked plating for distal radius fractures. J Hand Surg Am 38:40–48. CrossRefPubMedGoogle Scholar
  9. 9.
    Chen NC, Jupiter JB (2007) Management of distal radial fractures. J Bone Joint Surg Am 89:2051–2062. PubMedCrossRefGoogle Scholar
  10. 10.
    Gruber G, Gruber K, Giessauf C, Clar H, Zacherl M, Fuerst F, Bernhardt GA (2008) Volar plate fixation of AO type C2 and C3 distal radius fractures, a single-center study of 55 patients. J Orthop Trauma 22:467–472. CrossRefPubMedGoogle Scholar
  11. 11.
    Sharma H, Khare GN, Singh S, Ramaswamy AG, Kumaraswamy V, Singh AK (2014) Outcomes and complications of fractures of distal radius (AO type B and C): volar plating versus nonoperative treatment. J Orthop Sci 19:537–544. CrossRefPubMedGoogle Scholar
  12. 12.
    Müller ME, Nazarian S, Koch P, Schatzker J (1990) The comprehensive classification of fractures of long bones. Springer-Verlag, BerlinCrossRefGoogle Scholar
  13. 13.
    Medoff RJ (2005) Essential radiographic evaluation for distal radius fractures. Hand Clin 21:279–288. CrossRefPubMedGoogle Scholar
  14. 14.
    Knirk JL, Jupiter JB (1986) Intra-articular fractures of the distal end of the radius in young adults. J Bone Joint Surg Am 68:647–659CrossRefPubMedGoogle Scholar
  15. 15.
    MacDermid JC, Turgeon T, Richards RS, Beadle M, Roth JH (1998) Patient rating of wrist pain and disability: a reliable and valid measurement tool. J Orthop Trauma 12:577–586CrossRefPubMedGoogle Scholar
  16. 16.
    Beaton DE, Wright JG, Katz JN, The Upper Extremity Collaborative Group (2005) Development of the quick-DASH: comparison of three item-reduction approaches. J Bone Joint Surg Am 87:1038–1046. PubMedCrossRefGoogle Scholar
  17. 17.
    Earp BE, Foster B, Blazar PE (2015) The use of a single volar locking plate for AO C3-type distal radius fractures. Hand 10:649–653. CrossRefPubMedGoogle Scholar
  18. 18.
    Rubinovich RM, Rennie WR (1983) Colles’ fracture: end results in relation to radiologic parameters. Can J Surg 26:361–363PubMedGoogle Scholar
  19. 19.
    Batra S, Gupta A (2002) The effect of fracture-related factors on the functional outcome at 1 year in distal radius fractures. Injury 33:499–502. CrossRefPubMedGoogle Scholar
  20. 20.
    Mann FA, Wilson AJ, Gilula LA (1992) Radiographic evaluation of the wrist: what does the hand surgeon want to know? Radiology 184:15–24. CrossRefPubMedGoogle Scholar
  21. 21.
    Lee SJ, Park JW, Kang BJ, Lee JI (2016) Clinical and radiologic factors affecting functional outcomes after volar locking plate fixation of dorsal angulated distal radius fractures. J Orthop Sci 21:619–624. CrossRefPubMedGoogle Scholar
  22. 22.
    Young BT, Rayan GM (2000) Outcome following nonoperative treatment of displaced distal radius fractures in low demand patients older than 60 years. J Hand Surg Am 25:19–28. CrossRefPubMedGoogle Scholar
  23. 23.
    Arora R, Gabl M, Gschwentner M, Deml C, Krappinger D, Lutz M (2009) A comparative study of clinical and radiologic outcomes of unstable colles type distal radius fractures in patients older than 70 years: nonoperative treatment versus volar locking plating. J Orthop Trauma 23:237–242. CrossRefPubMedGoogle Scholar
  24. 24.
    Kumar S, Penematsa S, Sadri M, Deshmukh SC (2008) Can radiological results be surrogate markers of functional outcome in distal radial extra-articular fractures? Int Orthop 32:505–509. CrossRefPubMedGoogle Scholar
  25. 25.
    Plant CE, Parsons NR, Costa ML (2017) Do radiological and functional outcomes correlate for fractures of the distal radius? Bone Joint J 99:376–382. CrossRefPubMedGoogle Scholar
  26. 26.
    Bini A, Surace MF, Pilato G (2008) Complex articular fractures of the distal radius: the role of closed reduction and external fixation. J Hand Surg Eur 33:305–310. CrossRefGoogle Scholar
  27. 27.
    Ruckenstuhl P, Bernhardt GA, Sadoghi P, Glehr M, Holzer LA, Leithner A, Wolf M, Gruber G (2014) Quality of life after volar locked plating: a 10-year follow-up study of patients with intra-articular distal radius fractures. BMC Musculoskelet Disord 15:250. CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© SICOT aisbl 2018

Authors and Affiliations

  1. 1.Department of Orthopaedic SurgeryElda University HospitalAlicanteSpain
  2. 2.Faculty of Health SciencesUniversity of AlicanteAlicanteSpain

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