Skip to main content


Log in

Outcomes After Volar Plate Fixation of Low-grade Open and Closed Distal Radius Fractures Are Similar

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®



Low-grade (Gustilo and Anderson Type I or II) open distal radius fractures (DRFs) have been treated by volar locking plate fixation. However, it is unclear whether the outcomes after volar locking plate fixation for low-grade open DRFs are comparable to those for closed DRFs.


We asked whether low-grade open DRFs had worse DASH scores and higher infection rates than closed DRFs when the DRFs were treated by volar plate fixation.


Twenty consecutive patients treated by volar locking plate fixation for low-grade open DRFs constituted the open fracture group, and 40 patients were selected from among the total number of patients treated by volar, locking plate fixation for closed DRFs as the closed fracture group. Complications including infection were recorded. Clinical outcomes and radiographic assessments were performed postoperatively at 3 months and 1 year.


At 3 postoperative months, wrist flexion and extension, grip strengths, and DASH scores were better in the closed fracture group; however, no difference was observed postoperatively between the two groups in terms of any functional outcome measure at 1 year. Any of the radiographic parameters were not different between the groups. There were no differences in infection rate and in any other complication rate between the groups.


Although functional outcomes of open DRFs were inferior to those of closed DRFs at 3 months, at 1 year, outcomes of low-grade open DRFs were found to be comparable to those of closed DRFs when volar plate fixation was used.

Level of Evidence

Level III, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others


  1. Chung KC, Shauver MJ, Birkmeyer JD. Trends in the United States in the treatment of distal radial fractures in the elderly. J Bone Joint Surg Am. 2009;91:1868–1873.

    Article  PubMed  Google Scholar 

  2. Cole RJ, Bindra RR, Evanoff BA, Gilula LA, Yamaguchi K, Gelberman RH. Radiographic evaluation of osseous displacement following intra-articular fractures of the distal radius: reliability of plain radiography versus computed tomography. J Hand Surg Am. 1997;22:792–800.

    Article  PubMed  CAS  Google Scholar 

  3. Crosby CA, Wehbe MA. Hand strength: normative values. J Hand Surg Am. 1994;19:665–670.

    Article  PubMed  CAS  Google Scholar 

  4. Duncan R, Geissler W, Freeland AE, Savoie FH. Immediate internal fixation of open fractures of the diaphysis of the forearm. J Orthop Trauma. 1992;6:25–31.

    PubMed  CAS  Google Scholar 

  5. Glueck DA, Charoglu CP, Lawton JN. Factors associated with infection following open distal radius fractures. Hand (NY). 2009;4:330–334.

    Article  Google Scholar 

  6. Goldfarb CA, Yin Y, Gilula LA, Fisher AJ, Boyer MI. Wrist fractures: what the clinician wants to know. Radiology. 2001;219:11–28.

    PubMed  CAS  Google Scholar 

  7. Gustilo RB, Anderson JT. Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses. J Bone Joint Surg Am. 1976;58:453–458.

    PubMed  CAS  Google Scholar 

  8. Hudak PL, Amadio PC, Bombardier C. Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand) [corrected]. The Upper Extremity Collaborative Group (UECG). Am J Ind Med. 1996;29:602–608.

    Article  PubMed  CAS  Google Scholar 

  9. Kim JK, Koh YD, Do NH. Should an ulnar styloid fracture be fixed following volar plate fixation of a distal radial fracture? J Bone Joint Surg Am. 2010;92:1–6.

    Article  PubMed  Google Scholar 

  10. Kim JK, Koh YD, Kook SH. Effect of calcium phosphate bone cement augmentation on volar plate fixation of unstable distal radial fractures in the elderly. J Bone Joint Surg Am. 2011;93:609–614.

    Article  PubMed  Google Scholar 

  11. Knirk JL, Jupiter JB. Intra-articular fractures of the distal end of the radius in young adults. J Bone Joint Surg Am. 1986;68:647–659.

    PubMed  CAS  Google Scholar 

  12. Kurylo JC, Axelrad TW, Tornetta P 3rd, Jawa A. Open fractures of the distal radius: the effects of delayed debridement and immediate internal fixation on infection rates and the need for secondary procedures. J Hand Surg Am. 2011;36:1131–1134.

    Article  PubMed  Google Scholar 

  13. Marsh JL, Slongo TF, Agel J, Broderick JS, Creevey W, DeCoster TA, Prokuski L, Sirkin MS, Ziran B, Henley B, Audigé L. Fracture and dislocation classification compendium - 2007: Orthopaedic Trauma Association classification, database and outcomes committee. J Orthop Trauma. 2007;21(10 suppl):S1–133.

    Article  PubMed  CAS  Google Scholar 

  14. Mattila VM, Huttunen TT, Sillanpää P, Niemi S, Pihlajamäki H, Kannus P. Significant change in the surgical treatment of distal radius fractures: a nationwide study between 1998 and 2008 in Finland. J Trauma. 2011;71:939–942; discussion 942–943.

    Article  PubMed  Google Scholar 

  15. Medoff RJ. Essential radiographic evaluation for distal radius fractures. Hand Clin. 2005;21:279–288.

    Article  PubMed  Google Scholar 

  16. Moed BR, Kellam JF, Foster RJ, Tile M, Hansen ST Jr. Immediate internal fixation of open fractures of the diaphysis of the forearm. J Bone Joint Surg Am. 1986;68:1008–1017.

    PubMed  CAS  Google Scholar 

  17. Orbay J. Volar plate fixation of distal radius fractures. Hand Clin. 2005;21:347–354.

    Article  PubMed  Google Scholar 

  18. Orbay J, Badia A, Khoury RK, Gonzalez E, Indriago I. Volar fixed-angle fixation of distal radius fractures: the DVR plate. Tech Hand Up Extrem Surg. 2004;8:142–148.

    Article  PubMed  Google Scholar 

  19. Orbay JL, Fernandez DL. Volar fixed-angle plate fixation for unstable distal radius fractures in the elderly patient. J Hand Surg Am. 2004;29:96–102.

    Article  PubMed  Google Scholar 

  20. Petersen P, Petrick M, Connor H, Conklin D. Grip strength and hand dominance: challenging the 10% rule. Am J Occup Ther. 1989;43:444–447.

    Article  PubMed  CAS  Google Scholar 

  21. Rozental TD, Beredjiklian PK, Steinberg DR, Bozentka DJ. Open fractures of the distal radius. J Hand Surg Am. 2002;27:77–85.

    Article  PubMed  Google Scholar 

  22. Scheer JH, Adolfsson LE. Radioulnar laxity and clinical outcome do not correlate after a distal radius fracture. J Hand Surg Eur Vol. 2011;36:503–508.

    Article  PubMed  CAS  Google Scholar 

  23. Soong M, van Leerdam R, Guitton TG, Got C, Katarincic J, Ring D. Fracture of the distal radius: risk factors for complications after locked volar plate fixation. J Hand Surg Am. 2011;36:3–9.

    Article  PubMed  Google Scholar 

  24. Yang EC, Eisler J. Treatment of isolated type I open fractures: is emergent operative debridement necessary? Clin Orthop Relat Res. 2003;410:289–294.

    Article  PubMed  Google Scholar 

  25. Yu YR, Makhni MC, Tabrizi S, Rozental TD, Mundanthanam G, Day CS. Complications of low-profile dorsal versus volar locking plates in the distal radius: a comparative study. J Hand Surg Am. 2011;36:1135–1141.

    Article  PubMed  Google Scholar 

Download references


We thank Kyoung Ae Gong MD, PhD, of the Department of Preventive Medicine for help and advice on the statistical analysis and Jung Mee No BD, for performing physical examinations and collecting the self-reported questionnaires.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Jae Kwang Kim MD, PhD.

Additional information

Each author certifies that he has no commercial association (eg, consultancies, stock ownership, equity interest, patent/licensing arrangement, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Clinical Orthopaedics and Related Research neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA approval status, of any drug or device before clinical use.

Authors certify that our institution has approved the reporting of these cases, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participating in the study was obtained.

About this article

Cite this article

Kim, J.K., Park, S.D. Outcomes After Volar Plate Fixation of Low-grade Open and Closed Distal Radius Fractures Are Similar. Clin Orthop Relat Res 471, 2030–2035 (2013).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: