Background and Objectives: The distal radius fracture (DRF) is a major public health problem in northern countries. Its frequency is constantly increasing. The locked anterior plate with its well-established biomechanical properties, offers a reliable alternative. The aim of this study was to evaluate the radiological, the functional results and to determine the factors of poor postoperative prognosis of DRF treated with Newclip radial plates？. Methodology: This prospective cohort study evaluates the radiological and functional outcames of displaced radius fractures (DRFs) in patients ≥50 years old treated with Newclip？ (locked anterior plates) at the Basse-Terre Hospital in Guadeloupe from 2022 to 2024. The patients were categorized into those with epiphyseal involvement (E1 - E4) and without epiphyseal involvement (E0) based on Laulan’s MEU classification. Radiological parameters (distal radio-ulnar index (DRUI), radial inclination frant view (IRF), radial inclination sagittal view (IRS) were assessed pre and post-operatively. Functional recovery was evaluated at 12 months using the QuickDash questionnaire. Results: Falls were the most common cause of fracture. Post-operatively, SRI was the least restored parameter. Poor prognostic factor for SRI improvement included posterior commimution and unstable fractures. Factors associated with higher QuickDash scores included unstable factures, unrestored DRUI, low plate position, metaphyseal features, and ulnar features. Conclusion: The anterior locking plate osteosynthesis is reliable treatment option with excellent functional outcomes.
References
[1]
Court-Brown, C.M. and Caesar, B. (2006) Epidemiology of Adult Fractures: A Review. Injury, 37, 691-697. https://doi.org/10.1016/j.injury.2006.04.130
[2]
Huttinen, T.T. (2014) Surgical Traitement of Upper Limb Fractures An Evidence-Based Approach. University of Tampere.
[3]
Fowler, J.R. and Ilyas, A.M. (2013) Prospective Evaluation of Distal Radius Fractures Treated with Variable-Angle Volar Locking Plates. TheJournalofHandSurgery, 38, 2198-2203. https://doi.org/10.1016/j.jhsa.2013.08.116
[4]
Cummings, S.R. (1989) Lifetime Risks of Hip, Colles’, or Vertebral Fracture and Coronary Heart Disease among White Postmenopausal Women. ArchivesofInternalMedicine, 149, 2445-2448. https://doi.org/10.1001/archinte.1989.00390110045010
[5]
Figl, M., Weninger, P., Liska, M., Hofbauer, M. and Leixnering, M. (2009) Volar Fixed-Angle Plate Osteosynthesis of Unstable Distal Radius Fractures: 12 Months Results. ArchivesofOrthopaedicandTraumaSurgery, 129, 661-669. https://doi.org/10.1007/s00402-009-0830-z
[6]
Cizemba, J., Bakumobatane, L.M., Mutombo, E.K., Mukendi, M.K., Kabengele, R.M., Bamuleka, D.M., et al. (2023) Upper Limb Fractures in Kinshasa: Therapeutic Approach in a Sub-Saharan African Country. OpenJournalofOrthopedics, 13, 405-420. https://doi.org/10.4236/ojo.2023.1310040
[7]
Bradway, J.K., Amadio, P.C. and Cooney, W.P. (1989) Open Reduction and Internal Fixation of Displaced, Comminuted Intra-Articular Fractures of the Distal End of the Radius. TheJournalofBone&JointSurgery, 71, 839-847. https://doi.org/10.2106/00004623-198971060-00007
[8]
Boretto, J.G., Gallucci, G.L., Alfie, V.A., Donndorff, A. and De Carli, P. (2009) Les fractures intraarticulaires du radius distal à déplacement postérieur traitées par plaque palmaire à stabilité angulaire. Technique et résultats. Chirurgie de la Main, 28, 18-25. https://doi.org/10.1016/j.main.2008.11.005
[9]
Egol, K.A., Kubiak, E.N., Fulkerson, E., Kummer, F.J. and Koval, K.J. (2004) Biomechanics of Locked Plates and Screws. JournalofOrthopaedicTrauma, 18, 488-493. https://doi.org/10.1097/00005131-200409000-00003
[10]
Stenley, L. (2016) Fractures de l’extrémité distale du radius ostéosynthésées par plaque antérieure verrouillée: Étude prospective de 81 patients. Master’s Thesis, Université de Picardie Jules Verne.
[11]
Viberg, B., Tofte, S., Rønnegaard, A.B., Jensen, S.S., Karimi, D. and Gundtoft, P.H. (2023) Changes in the Incidence and Treatment of Distal Radius Fractures in Adults—A 22-Year Nationwide Register Study of 276,145 Fractures. Injury, 54, Article ID: 110802. https://doi.org/10.1016/j.injury.2023.05.033
[12]
Koval, K.J., Harrast, J.J., Anglen, J.O. and Weinstein, J.N. (2008) Fractures of the Distal Part of the Radius. TheJournalofBoneandJointSurgery-AmericanVolume, 90, 1855-1861. https://doi.org/10.2106/jbjs.g.01569
[13]
Marchewka, J., Marchewka, W. and Golec, E. (2021) Quality of Life after Distal Radius Fractures. RehabilitacjaMedyczna, 24, 13-18. https://doi.org/10.5604/01.3001.0014.8656
[14]
Jayaram, M., Wu, H., Yoon, A.P., Kane, R.L., Wang, L. and Chung, K.C. (2023) Comparison of Distal Radius Fracture Outcomes in Older Adults Stratified by Chronologic vs Physiologic Age Managed with Casting vs Surgery. JAMANetworkOpen, 6, e2255786. https://doi.org/10.1001/jamanetworkopen.2022.55786
[15]
Chen, C.H., Zhou, R.K., Zhen, H.Q., Huang, L. and Jiao, Y.J. (2015) Efficacy of Volar and Dorsal Plate Fixation for Unstable Dorsal Distal Radius Fractures. International Journal of Clinical and Experimental Medicine, 8, 4375-4380.
[16]
Lafontaine, M., Delince, P., Hardy, D. and Simons, M. (1989) Instability of Fractures of the Lower End of Radius: A Propos of a Series of 167 Cases. Acta Orthopaedica Belgica, 55, 203-216.
[17]
Hanane, A. (2008) Les fractures distales du radius, analyse radiologique. Université cadi Ayyad Marrakesh.
[18]
Chung, K.C. and Spilson, S.V. (2001) The Frequency and Epidemiology of Hand and Forearm Fractures in the United States. TheJournalofHandSurgery, 26, 908-915. https://doi.org/10.1053/jhsu.2001.26322
[19]
Dahmi, Z. (2009) Le traitement chirurgical des fractures de l’extrémité distale du ra-dius. Revue de Chirurgie Orthopédique et Traumatologique, 39, 18-23.
[20]
Dumontier, C. and Herzberg, G. (2001) Classifications du radius distal. Revue de Chirurgie Orthopédique et Traumatologique, 87, S78-S85.
[21]
Mignemi, M.E., Byram, I.R., Wolfe, C.C., Fan, K., Koehler, E.A., Block, J.J., etal. (2013) Radiographic Outcomes of Volar Locked Plating for Distal Radius Fractures. TheJournalofHandSurgery, 38, 40-48. https://doi.org/10.1016/j.jhsa.2012.10.007
[22]
Jeudy, J., Steiger, V., Boyer, P., Cronier, P., Bizot, P. and Massin, P. (2012) Treatment of Complex Fractures of the Distal Radius: A Prospective Randomised Comparison of External Fixation ‘versus’ Locked Volar Plating. Injury, 43, 174-179. https://doi.org/10.1016/j.injury.2011.05.021
[23]
Obert, L., Rey, P., Uhring, J., Gasse, N., Rochet, S., Lepage, D., etal. (2013) Ostéosynthèse des fractures du radius distal chez l’adulte: Mise au point. RevuedeChirurgieOrthopédiqueetTraumatologique, 99, 174-191. https://doi.org/10.1016/j.rcot.2012.05.012
[24]
Short, W.H., Palmer, A.K., Werner, F.W. and Murphy, D.J. (1987) A Biomechanical Study of Distal Radial Fractures. TheJournalofHandSurgery, 12, 529-534. https://doi.org/10.1016/s0363-5023(87)80202-2
[25]
Taleisnik, J. and Watson, H.K. (1984) Midcarpal Instability Caused by Malunited Fractures of the Distal Radius. TheJournalofHandSurgery, 9, 350-357. https://doi.org/10.1016/s0363-5023(84)80222-1
[26]
Kihara, H., Palmer, A.K., Werner, F.W., Short, W.H. and Fortino, M.D. (1996) The Effect of Dorsally Angulated Distal Radius Fractures on Distal Radioulnar Joint Congruency and Forearm Rotation. TheJournalofHandSurgery, 21, 40-47. https://doi.org/10.1016/s0363-5023(96)80152-3
[27]
Karnezis, I.A., Panagiotopoulos, E., Tyllianakis, M., Megas, P. and Lambiris, E. (2005) Correlation between Radiological Parameters and Patient-Rated Wrist Dysfunction Following Fractures of the Distal Radius. Injury, 36, 1435-1439. https://doi.org/10.1016/j.injury.2005.09.005
[28]
Jenkins, N.H. and Mintowt-Czyz, W.J. (1988) Mal-Union and Dysfunction in Colles’ Fracture. JournalofHandSurgery, 13, 291-293. https://doi.org/10.1016/0266-7681_88_90090-3
Werner, F.W., Glisson, R.R., Murphy, D.J. and Palmer, A.K. (1986) Force Transmission Trough the Distal Radioulnar Carpal Joint: Effect of Ulnar Lengthening and Shortening. Handchirurgie, 18, 304-308.
[31]
McQueen, M. and Caspers, J. (1988) Colles Fracture: Does the Anatomical Result Affect the Final Function? TheJournalofBoneandJointSurgery.Britishvolume, 70, 649-651. https://doi.org/10.1302/0301-620x.70b4.3403617
