Comparison of Fixation Stability and Incidence of Extensor Tendon Injury according to the Screw Insertion Method in Volar Plate Fixation for Distal Radius Fractures / 대한정형외과학회잡지

ABSTRACT

PURPOSE: This retrospective study was aimed to analyze the differences in stability and extensor impairment after two different volar plating procedures to manage unstable distal radius fracture, which were the penetration of only near-cortex followed by screw fixation (Group 1) and perforation of dorsal cortex by drill-bit followed by fixation with the screws downsized after gauging (Group 2). MATERIALS AND METHODS: We reviewed the medical records of 491 patients with distal radius fracture treated with standard-sized, targeted distal radius plate in two institutions between April 2009 and May 2014. Finally, 341 patients with complete demographic data, records of AO classification of fractures, data on the lengths of inserted distal screws, radiologic parameters immediately and at 3 months after operation, as well as extensor impairments, were included in this study. There were 112 patients (98 women and 14 men) in Group 1, and 229 patients (171 women and 58 men) in Group 2. The mean age was 59.8 years for all the patients; 60.3 years in Group 1 and 59.5 years in Group 2. RESULTS: The mean length of the longest screws used in Group 2 was longer than that in Group 1; however, the mean length of the shortest screws used in Group 2 was shorter than that in Group 1. While the differences in changes for radial inclination measured immediately and at 3 months after the operation were statistically significant (p=0.019), the change of radial inclination in Group 2, which showed a greater change, was only 0.5 mm. There were two cases with extensor pollicis longus rupture in Group 1 and 2 respectively, and the difference in frequency according to each Group was not statistically significant (p=0.6). CONCLUSION: The superiority of one surgical procedure in terms of fracture stability on measured radiological parameters was not fully proven compared with the other one in this study. Therefore, it would be better to selectively use the surgical method of dorsal cortex perforation viadrill-bit followed by fixation only in limited circumstances.