LOCKED ANTERIOR PLATE FIXATION OF COMPLEX FRACTURES OF THE DISTAL RADIUS: PRELIMINARY RESULTS IN 43 CASES

Abstract

Purpose of the study: Locked plating is an attractive alternative to external fixation for the fixation of distal shaft fractures of the radius, particularly in cases with metaphyseal comminution. The purpose of this study was to assess prospectively outcome with locked anterior plate fixation in a series of 43 complex fractures of the distal radius treated between October 2003 and November 2004.

Material and methods: The AO LCP 3.5 plate (Synthes) was used. The series included 27 women and 15 men, mean age 55.5 years (range 17–83 years). We included fractures with major metaphyseal comminution according to the M.E.C classification established by Laulan (18 M2, 14 M3, and 9 M4). According to the AO classification, there were nine extra-articular fractures (eight A3 and one A2) and 35 articular fractures (ten B3, two C1, four C2, and seventeen C3). Posterior displacement was noted for 22 fractures. In eight cases plate fixation was a second intention procedure due to secondary displacement occurring on average eight days (range 3–21 days) after trauma for a fracture initially treated with infrafocal pinning. An epiphyseal locking screw was used in all cases. An antebrachiopalmar immobilization orthesis was worn for six weeks on average (range 3–9 weeks). The first-intention anterior plating was combined with an intrafocal posterior pin for 13 patients and with an external fixator in one. Radiographic outcome was reported in terms of joint congruency and using the SOFCOT symposium criteria for the 41 patients reviewed at bone healing.

Results: Anatomic restitution was achieved in 23 patients (55%). There were two purely intra-articular calluses due to failure of the primary reduction, both measured less than 2 mm. Fifteen moderate misalignements (36%) were noted, most (84.7%) involving moderate sagittal inclination, the distal radioulnar index being preserved. Two major misalignments (5%) were related to early disassembly of the osteosynthesis.

Conclusion: Locked anterior plating has provided promising results for maintaining radial length in distal radial fractures with major metaphyseal comminution. There remains a certain number of cases with a moderate and persistent posterior inclination and a few cases of defective intra-articular reduction.