Treatment of comminuted intra-articular fractures of the distal radius by open reduction and volar plating in adults

BACKGROUND: We herein present the mid-term results of the adult patients with communited intra-articular fractures of the distal radius who were treated by palmar plating.
METHODS: Between 1999 and 2003, open reduction and palmar plating were performed in 23 of the patients who had surgical treatment for comminuted intra-articular fractures of the distal radius. Nineteen patients (11 females, 8 males; mean age 34; range 22 to 54 years) with regular follow-up were included in the study. In the majority of patients only one wrist was involved (7 dominant - 12 nondominant). Preoperative evaluation included patient’s history, physical examination, and radiological studies (plain radiographs, computed tomography). The patients were classified according to AO classification as 7 type B [B1 (1); B2 (3); B3 (3)] and 12 type C [C1 (7); C2 (5)]. The surgical procedure included internal fixation by using plates and screws with palmar approach. Range of motion exercises were started immediately after the operations. The patients were followed clinically and radiographically, with an average follow-up time of 28 months (range, 13-47 months). Complications were recorded.
RESULTS: Union was achieved in all patients. Radiographic parameters including the radial height, radial inclination, palmar tilt, and articular congruency have been corrected in the operation and remained unchanged until the last follow-up. According to the Gartland and Werley’s classification, there were 9 (47%) excellent, 7 (37%) good, and 3 (16%) fair results. No perioperative and postoperative complications were recorded, except for three wound problems and one prolonged scar tenderness.
CONCLUSION: Palmar plating is a safe and effective treatment for comminuted intraarticular fractures of the distal radius, regardless of direction of displacement of the distal fragment.

Yetiþkinlerde parçalý intraartiküler distal radius kýrýklarýnýn açýk redüksiyon ve voler plaklamayla tedavisi

AMAÇ: Parçalý intraartiküler distal radius kýrýklarýnda voler plaklama ile tedavi edilen yetiþkin hastalarýn orta dönem takip sonuçlarý sunuldu.
GEREÇ-YÖNTEM: 1999-2003 yýllarý arasýnda parçalý intraartiküler distal radius kýrýðý nedeniyle ameliyat edilen eriþkin hastalardan 23 tanesine açýk redüksiyon ve voler plaklama uygulandý. Düzenli takipleri yapýlan 19 hasta (11 kadýn, 8 erkek; ort. yaþ 34; daðýlým 22-54) çalýþmaya dahil edildi. Yaralanma çoðu hastada sadece tek el bileðiyle sýnýrlýydý (7 dominant - 12 nondominant). Hastalarýn ameliyat öncesi deðerlendirmeleri hikaye, fizik muayene ve radyolojik incelemeleri (direkt grafiler, bilgisayarlý tomografi) içerdi. AO/ASIF kriterlerine göre hastalarýn 7’si tip B [B1 (1); B2(3); B3(3)], kalan 12’si ise tip C [C1(7); C2(5)] þeklinde sýnýflandý. Cerrahi prosedür voler yaklaþýmla, plak ve vidalar kullanýlarak internal fiksasyon uygulamasýný içerdi. Ameliyat sonrasý erken dönemde hareket açýklýðý egzersizlerine baþlandý. Hastalar klinik ve radyolojik olarak ortalama 28 ay (13 - 47 ay) takip edildi. Komplikasyonlar kaydedildi.
BULGULAR: Tüm hastalarda kaynama saðlandý. Radyografik parametreler; radyal yükseklik, radyal inklinasyon, voler eðim, ve eklem yüzey uyumsuzluklarý ameliyatla birlikte düzeltilerek son takiplere kadar korundu. Gartland ve Werley skorlamasýna göre hastalarýn 9’unda (%47) mükemmel, 7’sinde (%37) iyi ve 3’ünde de (%16) orta sonuçlar alýndý. Üç hastada yara sorunlarý ve bir hastada uzun süreli skar hassasiyeti geliþmesi dýþýnda ameliyat sýrasýnda ve ameliyat sonrasý baþka komplikasyonla karþýlaþýlmadý.
SONUÇ: Voler yaklaþýmla plaklama, intraartiküler distal radius kýrýklarýnýn tedavisinde, distal fragmanýn deplasman yönüne bakýlmaksýzýn, güvenilir ve etkili bir yöntemdir.