Session XII - Upper Extremity
A Prospective Multicenter Study of 156 Distal Radius Fractures Treated with Anatomically Shaped Implants
Introduction: A prospective multicenter study was initiated to evaluate the use of anatomically shaped plates applied in a fragment-specific approach. 156 patients met the inclusion criteria and fulfilled the targeted sample size.
Methods: 66 patients were male with a mean age of 43 years; 90 females had a mean age of 57.5 years. The mean body mass index was 25. 90 were working before their injury. 23 had concurrent diseases with 29 actively smoking. The dominant limb was involved in 86. The mean DASH score preoperatively was 2.
47 fractures occurred in the home; 35 sport and leisure; 41 in traffic; and 33 other. 65 fractures were high energy. 110 fractures were type C (23 C3, 50 C2, 37 C1); 18 were type B, and 28 type A. Two were open fractures. The ulna was involved in 74, with 56 ulnar styloid fractures.
123 fractures were treated with a volar approach, 19 dorsal, and 14 volar and dorsal. 18 had adjuvant bone graft while 10 had carpal tunnel release. Using a VAS scale of 0-10, the surgeon satisfaction with the treatment was 8.7.
At the time of this abstract, 124 patients had a 1-year follow-up and 80 a 2-year follow-up. The median time to return to work was 54 days.
Results: All but one fracture healed with one volar lunate facet fragment ununited. Using the VAS scale, the mean patient pain with motion was 1.2 and 0.6 at 2 years. Motion, measured as a percentage of the opposite side, was at 2 years: mean flexion 87.7%; extension 94%; radial deviation 100%; ulnar deviation 90%; pronation 98%; and supination 96%. Only ulnar and radial deviation improved from 1 to 2 years. Grip strength was 90.5% of opposite side at 2 years.
The Gartland Werley wrist score was excellent in 68 and good in 39 at 1 year and excellent in 58 and good in 25 at 2 years (note incomplete follow-up as yet). The DASH score went from mean 2.1 at baseline to 8.2 at 1 year and 5.9 at 2 years. There were no changes in the SF-36 from baseline to 2-year follow-up.
Radiographs at 2 years showed Grade I arthritis in 28% and Grade II in 4%.
There were 22 adverse events with 9 involving soft tissue but only one tendon rupture. Four were related to implant loosening and four loss of reduction. The remainders were various problems such as pain or digital stiffness.
Conclusions: This large prospective study reveals the overall efficacy of internal plate fixation of the majority of distal radius fractures. While physician- and patient-rated outcomes improved, at 2 years the DASH still reveals mild dysfunction. The SF-36 is not a sensitive tool for evaluating outcome following distal radius fractures. Overall, little improvement in motion or strength occurs after 1 year. However, some radiographs revealed increase in arthrosis between 1 to 2 years.