Retrospective Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Oct 18, 2018; 9(10): 203-209
Published online Oct 18, 2018. doi: 10.5312/wjo.v9.i10.203
Screw placement is everything: Risk factors for loss of reduction with volar locking distal radius plates
Herwig Drobetz, Alyce Black, Jonathan Davies, Petra Buttner, Clare Heal
Herwig Drobetz, Alyce Black, Clare Heal, James Cook University School of Medicine and Dentistry, Mackay 4740, Queensland, Australia
Herwig Drobetz, Jonathan Davies, Clare Heal, Mackay Institute of Research and Innovation, Mackay Hospital, Mackay 4740, Queensland, Australia
Herwig Drobetz, Jonathan Davies, Mackay Base Hospital Orthopaedic Department, Mackay Hospital, Mackay 4740, Queensland, Australia
Petra Buttner, Tropical Health Solutions PTY Ltd, Townsville 4810, Queensland, Australia
Petra Buttner, Centre for Chronic Disease Prevention, James Cook University, Cairns 4878, Queensland, Australia
Clare Heal, Anton Breinl Research Centre for Health Systems Strengthening, Townsville 4810, Queensland, Australia
Author contributions: Drobetz H, Black A, Davies J, and Heal C developed the study protocol; Drobetz H, Black A, Davies J initiated the study, and performed literature research and proofreading for scientific content; Drobetz H and Black A participated in patient recruitment and follow-up, data collection, and writing of the manuscript; Heal C performed statistical analysis and interpretation, write up of data, preparation of ethics submission, and provided overall oversight of conduct of study; Buttner P performed statistical analysis of raw data, and revised the manuscript for statistical content.
Institutional review board statement: This study was reviewed and approved by the Human Research Ethics Committee of Queensland Health, Australia.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: All authors declare no conflicts-of-interest related to this article.
Open-Access: This is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Herwig Drobetz, MD, PhD, Professor, Director of Orthopaedics, Department of Orthopaedics, Mackay Hospital and Health District, Bridge Road, Mackay 4740, Queensland, Australia. herwig.dro@gmail.com
Telephone: +61-748-857900 Fax: +61-748-857900
Received: April 30, 2018
Peer-review started: April 30, 2018
First decision: May 16, 2018
Revised: June 28, 2018
Accepted: August 20, 2018
Article in press: August 21, 2018
Published online: October 18, 2018
Processing time: 171 Days and 5 Hours
ARTICLE HIGHLIGHTS
Research background

Treatment of distal radius fractures with volar locking distal radius plates (VLDRP) has become the most popular treatment method in the last ten years. Biomechanical and clinical studies indicate that distal screw placement as close as possible to the articular surface is crucial to prevent loss of postoperative reduction. To our knowledge, no study has been undertaken that proves or disproves this observation.

Research motivation

Our hypothesis was that postoperative loss of reduction will occur when the distal VLDRP screws are placed more proximal, in the distal radius fragment metaphysis, rather than in the subchondral hard area close to the articular surface. We also hypothesized that the loss of postoperative reduction is directly related to the distance of the distal screws from the articular surface. We undertook a retrospective study analyzing pre- and postoperative X-rays of 250 consecutive distal radius fractures treated with VLDRP.

Research objectives

Objectives of the study were to determine factors correlated with postoperative radial shortening in patients with distal radius fractures treated with VLDRPs.

Research methods

This is a longitudinal multicentre retrospective cohort study including patients who underwent VLDRP fixation of a dorsally displaced distal radius fracture in which 250 wrist fractures were included. Collected parameters were fracture classification, radial length, radial inclination, volar inclination of the joint surface, patient age, gender, mechanism of injury, likelihood of osteoporosis, comorbidities and postoperative immobilisation. The distance of the distal locking screws to the articular surface was measured on intraoperative lateral tilted X-rays. Radial shortening as a parameter of loss of reduction was measured on X-rays obtained at a minimum of six weeks postoperatively. Bivariate statistical comparisons were used to identify factors influencing postoperative radial shortening. Multiple linear regression analysis then identified independent factors associated with postoperative radial shortening.

Research results

Multiple linear regression analysis showed that the distance of the distal locking screws from the articular surface was the only independent factor associated with radial shortening. The relationship between shortening and distance of the distal screws to the articular surface was linear and statistically highly significant.

Research conclusions

Our study showed that in order to prevent postoperative loss of reduction in fractures plated with VLDRP, it is crucial that the distal screws are placed as close as possible to the articular surface. The study further indicated that loss of postoperative reduction is not associated with any other parameters measured - age, gender, osteoporosis, ASA status, fracture severity, immobilisation, number of distal screws and the presence or absence of a second distal screw row.

Research perspectives

A major advantage of treating distal radius fractures with VLDRP is that patients can be treated without postoperative immobilisation. VLDRP are in fact the only treatment modality that allows for immediate postoperative use of the wrist. Based on the findings of our study and provided that the distal screws are placed as close as possible to the articular surface, immediate postoperative mobilization should be possible without loss of reduction. Future studies should attempt to verify our findings in a clinical setting.