Volar Locking Plate Fixations for Displaced Distal Radius Fractures: An Evaluation of Complications and Radiographic Outcomes

Abstract

Background: A volar locking plate (VLP) is the most frequently used form of implant used for open reduction and internal fixation of distal radius fractures. They are known to have a complication rate of up to 27%. We hypothesized that plate design could influence complication rates. Methods: We performed a review of patients undergoing VLP fixation for distal radius fracture. A total of 228 patients underwent fixation with the Distal Volar Radial Anatomical (DVR) plate; 388 patients underwent fixation with the VariAx plate. Independent observers performed blinded case note and radiographic review, to assess for the quality of reduction, and complications for the inserted VLP. Results: Mean time to surgery was 6.0 days; mean follow-up was 17.5 weeks. Mean age was 56.5 years. The quality of reduction was classified as anatomical (46%), good (36.3%), moderate (13.0%), or poor (3.9%). Complications were identified in 109 patients (17%). Plate prominence was seen in 133 patients (21%). The DVR plate was less prominent ( P < .001) and had better overall radiographic appearances ( P = .025). Flexor tendon complications were related to plate prominence ( P = .005). Inferior reduction was associated with increased time to surgery ( P = .020). Conclusions: This study highlights the importance of prompt surgery, effective fracture reduction, and careful plate positioning to avoid volar prominence.