Distal radius fracture plating: Predictive factors influencing clinical outcome

BACKGROUND: Distal Radius Fractures (DRFs) are common and volar-locking-plating popular. We aimed to evaluate the disability after DRFs plating and its correlation with fracture-pattern and postoperative displacement. METHODS: Adult patients operated with locking-volar-plate for DRF between 01-01-2009 and 31-12-2019 were retrospectively evaluated by Q-DASH and PRWHE questionnaires and by radiographs. Fracture displacement at X-ray was detected between surgery and 30-days-after. RESULTS: Mean follow-up was 57-months. Mean age 57±13 years (19-80). 91/133(62%) were women. 75/133(56.4%) of DRFs were extra-articular-AO-23-A, 39(29.3%) partial-articular-AO-B and 19(14.3%) complete-intra-articular-AOC. Seventeen (13%) DRFs displaced after surgery: 12%(N.=9/75) A; 15%(N.=6/39) B; 21%(N.=4/19) C. 11/95(12%) below-65-years, 6/38(16%) above-65. Mean-Quick-DASH-score was 16.07±18.9; 12.9±16.4 type A, 19.69±20.05 B, 21.18±24.3 C; 12.74±16.6 A<65 years, 13.34±16.1 A>65 years, 18.25±18.2 B<65years, 24.48±26.0 B>65 years, 19.35±24.8 C<65 years, 23.69±24.9 C>65 years. Mean-PRWHE-score was 15.06±17.4; 16±6 (0-70) women, 14.61±16.70 (0-69) men; 12.38±14.9 type A, 17.10±19.02 B, 21.45±21.7 C; 11.95±14.50 A<65 years, 13.50±16.15 A>65 years, 16.07±17.14 B<65 years, 20.56±25.20 B>65 years, 23.68±22.87 C<65years, 18.37±21.21 C>65 years. CONCLUSIONS: Our case series demonstrates a good clinical outcome, worse in elderly and in AO type B fractures than in type C. Volar-locking-plate risks to mechanically fail in 1/10 wrist, 1/5 of intra-articular fractures, mostly in elderly. From AO 1-to-3 the clinical-outcome tends to worsen, and this can depend on the number of fracture fragments and grade of instability independently from the articular involvement. Severity of disability after wrist plating may depend on age, quality-of-bone, fracture-pattern and postoperative displacement. Other predictive factors of clinical outcome can reside in the associated capsulo-ligamentous and/or tendon lesions, in the time of surgical exposure, in the delayed surgery, and in the surgical aggressiveness. Even if clinical and radiographic outcome is not always fully satisfactory despite volar-locking-plating, its goal was to optimize the clinical outcome compared to other synthesis devices or the conservative treatments.