Volar locking plate (VLP) fixation contributes to immediate return to activity in patients with distal radius fractures, but poor results have been seen in some cases. In this study, we report on clinical findings affecting the Q-DASH score at 1 month postoperatively, which was used as a measure of immediate return to activity after VLP fixation.

Ninety-five patients who underwent VLP fixation for distal radius fracture at our hospital between July 2014 and January 2022 were divided into a good group (n=86; 22 males, 64 females; age 61.9) and a poor group (n=8; eight females; age 63.6) according to the quartiles of Q-DASH score at 1 month after VLP fixation. Duration from injury to surgery, direction of fracture dislocation, and radiographic parameters (radial inclination: RI, volar tilt: VT, ulnar variance: UV) at the time of injury were examined. Radiographic parameters (RI, VT, and UV), range of motion of the wrist joint, grip strength ratio, and visual analog scale (VAS) at 1 month after VLP fixation were also examined. These parameters were compared among both groups. Moreover, logistic regression analysis was performed to determine whether these factors were independently associated with poor Q-DASH score at 1 after VLP fixation.

At the time of injury, fracture displacement was significantly higher in the poor group (VT=−23.8°, UV=4.2mm) than the good group (VT=−6.5°, P=0.02; UV=1.3mm; P=0.01). No differences in other parameters were observed between the groups. At 1 month after VLP fixation, grip strength ratio (17.2%) in the poor group was significantly lower than the good group (43.8%, P<0.001), while VAS (5.6) in the poor group was significantly higher than the good group (2.4, P<0.001). Logistic regression analysis revealed that VT and UV at injury (P<0.05), grip strength ratio (P<0.001), and pain VAS (P<0.001) were all independently associated with poor Q-DASH score.

Fractures with large displacement at the time of injury have been found to hinder immediate return to activity, and intervention to treat osteoporosis, which is associated with the amount of fracture displacement, should be considered. The results also suggest that physical therapy to improve grip strength and postoperative pain management are important to promote immediate return to activity.

This study suggested that large amounts of fracture displacement, weakness of grip strength and postoperative pain can be interference factors to return to activity immediately after VLP fixation.