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Volar locked plating may not restore normal radiographic measurements
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SAN DIEGO — Volar locked plating is not ideal for restoring normal radiographic measurements of volar tilt, radial inclination, ulnar variance and radial height, according to a study presented here.
 Megan Mignemi |
The findings were presented by Megan Mignemi, MD, at the 2011 Annual Meeting of the American Academy of Orthopaedic Surgeons.
“Currently, there are no studies available that evaluate the ability of volar locked plating to restore the normal radiographic anatomy of the distal radius,” Mignemi said.
Study methods and parameters
To evaluate the ability of the procedure to restore anatomy, Mignemi and colleagues performed a retrospective review of 186 consecutive patients who underwent volar locked plating with a single plate for distal radius fractures during a 3-year period. Anteroposterior and lateral radiographs were taken for each patient from the time of injury, after reduction, at the initial postoperative follow-up and at a minimum of 6-weeks postoperative follow-up.
The group recorded measurements for volar tilt, radial inclination, ulnar variance and radial height. Articular step-off was categorized as either less than 2 mm or greater than or equal to 2 mm. The team used logistic regression to determine the association between return to historical anatomic normality and fracture type, age, gender and preoperative measurements.
Results
Mignemi reported articular congruence of less than 2 mm was observed in 91.9% of patients after volar locked plating. Normal volar tilt was restored in 45.9% of patients, with an average of 6.7°. Normal radial inclination was achieved in 43.8% of patients, with an average of 21.2°.
“Radial height was the measure least likely to be corrected by volar locked plating,” she said.
Mignemi said that normal ulnar variance was achieved in 53% of patients, with an average of 0.4 mm. Normal radial height was restored in 14.1% of patients, with a reported average of 10.8 mm.
The group was able to identify a significant association between correction of ulnar variance and fracture type using Frykman classification, and AO classification identified a significant association between restoration of volar tilt and fracture type.
What it means
“The literature suggests that anatomic reduction of distal radius fractures correlates to functional outcome,” Mignemi noted, citing studies that have found a decreased functional outcome with increased residual deformity of the distal radius after fracture and reduction.
“While we did not look at functional outcomes in our study, it has been demonstrated previously in the literature that perfect anatomic reduction is not necessary for acceptable functional outcomes,” she added. “Our study has shown that volar locked plating improves all radiographic measurements from the time of injury, but in only half of fractures were normal volar tilt, radial inclination and ulnar variance achieved.”
Reference:
- Mignemi M, et al. Radiographic outcomes of volar locked plating for distal radius fractures. Paper 331. Presented at the 2011 Annual Meeting of the American Academy of Orthopaedic Surgeons. Feb. 15-19, 2011. San Diego.
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