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Orthopaedics & Traumatology: Surgery & Research
Sous presse. Epreuves corrigées par l'auteur. Disponible en ligne depuis le samedi 25 août 2018
Doi : 10.1016/j.otsr.2018.04.009
Received : 23 October 2017 ;  accepted : 20 April 2018
Double-tiered subchondral support fixation with optimal distal dorsal cortical distance using a variable-angle volar locking-plate system for distal radius fracture in the elderly
 

Sang Ki Lee , Young Sub Chun, Hyun Min Shin, Soo Min Kim, Won Sik Choy
 Eulji University College of Medicine, Orthopedic Surgery, 1306 Dunsan-dong, 35233 Seo-gu Daejeon, Daejeon Korea, Republic of Korea 

Corresponding author. Eulji University College of Medicine, Orthopedic Surgery, 1306 Dunsan-dong, 35233 Seo-gu Daejeon, Daejeon Korea, Republic of Korea.Eulji University College of Medicine, Orthopedic Surgery1306 Dunsan-dongSeo-gu Daejeon, Daejeon Korea35233Republic of Korea
Abstract
Background

Double-tiered subchondral support (DSS) procedures with optimal distal dorsal cortical distance (DDD) have been reported to be effective in treating distal radius fractures, but there have been no studies of osteoporotic distal radius fractures in elderly patients. In this study, we demonstrated the efficacy of the DSS procedure with optimal DDD using a variable-angle volar locking-plate system for the treatment of osteoporotic distal radius fractures in elderly patients.

Methods

One hundred and twenty-two patients (mean age, 73.3 years; age range, 65–88 years) with distal radius fracture were treated using a variable-angle volar locking-plate system with DSS. Patients were divided into DSS and non-DSS groups based on postoperative and 12-month follow-up radiographs, and radiological and clinical assessment was performed. Finally, we divided all 122 patients into two groups based on volar tilt of 6° on 12-month follow-up radiographs, and postoperative DDD values were compared.

Results

Volar tilt decreased (p =0.02), and ulnar variance increased (p =0.01) more in the non-DSS group. The non-DSS group showed a significant correlation between postoperative DDD value and change in DDD value (p =0.00). The mean postoperative DDDs in the group with final volar tilt<6° and in the group with final volar tilt6° were 6.4mm (SD±1.7mm) and 4.6mm (SD±1.4mm) respectively (p =0.02). At 4-month follow-up, pronation (p =0.05) and supination (p =0.04) were improved, and at 12-month follow-up, supination (p =0.05) was improved in the DSS group.

Conclusion

The use of the DSS procedure and reduction of DDD to 4.6mm or less using a variable-angle volar locking-plate system was effective in maintaining anatomical reduction for the treatment of osteoporotic distal radius fractures in elderly patients.

Level of evidence

III Therapeutic study.

The full text of this article is available in PDF format.

Keywords : Distal radius fracture, Elderly, Double-tiered subchondral support, Distal dorsal cortical distance




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