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Distal Radius Fractures in the Elderly

Use of the Volar Bearing Plate

Miller, Jonathan E., MD; Naram, Aparajit, MD; Qin, BaiJing, MD; Rothkopf, Douglas M., MD

doi: 10.1097/SAP.0000000000001653
Hand Surgery

Background Distal radius fractures represent some of the most common injuries to the upper extremity, yet current evidence demonstrates great variability in the management of this injury. Elderly patients, in particular, stand to benefit from the early mobilization provided by operative fixation with a volar bearing plate.

Methods We conducted a retrospective chart review on all patients 65 years or older who underwent unilateral open reduction internal fixation of distal radius fractures using a volar bearing plate at a single institution between January 2014 and January 2016. We excluded patients with bilateral injuries, multiple fractures, and major injuries to the same extremity.

Results Fifty-five patients met criteria for this study. By AO classification, we repaired 17 type A, 24 type B, and 14 type C fractures. At final radiographic measurements, average radial height compared with ulna measured −0.31 mm, average radial inclination measured 20.45 degrees, and average volar tilt measured 7.11 degrees. On discharge, 36 patients had wrist range-of-motion data consistent with a functional wrist. Four patients had limitations in the flexion/extension plane, 8 with radial-ulnar deviation, and 7 had limitations in both planes.

Conclusions Distal radius fractures in the elderly may successfully be treated with a volar bearing plate. Useful strategies include supraperiosteal dissection of the radius from the pronator quadratus, use of a longer plate for stronger proximal fixation in osteoporotic bone, and regional block. This methodology allows for a safe procedure facilitating the early return of hand and wrist function.

From the Division of Plastic Surgery, University of Massachusetts Medical School.

Received April 2, 2018, and accepted for publication, after revision August 10, 2018.

Conflicts of interest and sources of funding: none declared.

All patients provided written consent for surgery after having risks and benefits of operative and nonoperative management presented.

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5). Informed consent was obtained from all patients for being included in the study.

Reprints: Jonathan E. Miller, MD, Division of Plastic Surgery, University of Massachusetts Medical School, 9 N Harvie St, Richmond, VA 23220. E-mail: Jonathan.Miller@vcuhealth.org.

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