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Distal Radius Fractures in the Elderly: Use of the Volar Bearing Plate
Aparajit Naram, MD, Jonathan Miller, BS, Baijing Qin, MD, Douglas M. Rothkopf, MD.
UMass Medical School, Worcester, MA, USA.

BACKGROUND: Distal radius fractures represent some of the most common fractures in the upper extremity. Current evidence suggests that long-term outcomes may be equivalent regardless of treatment modality. Evidence also suggests that choice of treatment varies greatly among physicians. Patients over the age of 65 present a unique challenge for the clinician. While many of these patients have low demand as retirees, they may benefit greatly from early mobilization and return to function for activities of daily living. We present our experience using the volar bearing plate under regional block with sedation in patients age 65 and older. METHODS: We conducted a retrospective chart review on all patients age 65 and older that underwent unilateral open reduction internal fixation of distal radius fractures using a volar bearing plate from January 2014 until January 2016. Patients with bilateral injuries or multiple fractures or major injuries to the same extremity were excluded. Patients with concomitant ulna styloid fractures not requiring fixation were included. We collected patient demographic data (age, hand injured, hand dominance, sex, occupation, and co-morbidities), injury data (mechanism, velocity, and fracture pattern according to Arbeitsgemeinschaft für Osteosynthesefragen or AO classification), operative data (tourniquet time, type of anesthesia and plate size), and post-operative outcomes (radiographs and range of motion measurements). RESULTS: We identified 32 patients (28 females, 4 males) with an average age of 74.5 years. Nine patients had a history of osteoporosis/osteopenia. By AO classification we repaired 11 class A, 13 class B, and 8 class C fractures. Twenty-three patients received a 5 hole plate, 7 patients received a 3 hole plate, and 2 patients received a 7 hole plate. Average tourniquet time was 84 minutes and all but 5 patients underwent surgery without general anesthesia. Radiographic data demonstrate an average pre-operative radial height of -1.90mm, average radial inclination of 16.53 degrees, and average volar tilt of -4.75 degrees. At final radiographic measurements (average = 90 days post-operatively), average radial height measures -0.28mm, average radial inclination measures 21.28 degrees and average volar tilt measures 7.75 degrees. On discharge, 20 patients had wrist range of motion data consistent with a functional wrist. Three patients had limitations in the flexion/extension plane, 5 patients with radial-ulnar deviation, and 4 patients had “stiff” wrists with limitations in both planes. Three patients developed complications during their care (two median nerve compressions, one non-fatal pulmonary embolism). To date, no patients have had complications of non-union or have required hardware removal. CONCLUSIONS: Distal radius fractures in the elderly may successfully be treated with a volar bearing plate. Some useful strategies include supraperiosteal dissection of the radius from the pronator quadratus minimizing disruption of comminuted fragments, use of a longer plate for stronger proximal fixation in patients with osteoporotic/osteopenic bone, and avoidance of general anesthesia by means of regional block. This methodology allows for a safe procedure facilitating the early return of hand and wrist function - freeing the elbow and rapidly mobilizing the wrist.

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