Comparison of outcomes between partially healed and acute metaphyseally malaligned distal radial fracture treated by palmar locking plate fixation.

Background: The purpose of this study was to determine whether a partially healed (surgical delay of 2-6 weeks) metaphyseally malaligned distal radius fracture (DRF) treated using the extended palmar approach with palmar locking plate fixation has poorer clinical or radiological outcomes than those of acute (surgical delay of ≤2 weeks) metaphyseally unstable DRF treated by palmar locking plate fixation.

Methods: We identified 24 patients (Group A) who were treated with palmar locking plate for a partially healed (surgical delay of 2-6 weeks) metaphyseally malaligned DRF. We selected 48 patients (Group B) who were treated with palmar locking plate among the acute (surgical delay of ≤2 weeks) metaphyseally unstable DRF to be individually matched in a 1:2 ratio for sex, age, and fracture type. The two study groups were compared with respect to clinical and radiological parameters. The clinical parameters examined were; wrist range of motion (flexion, extension, supination, and pronation), grip strength, and Disabilities of Arm, Shoulder and Hand (DASH) scores. Radiological measurements included radial inclination, palmar angulation, and ulnar variance.

Results: The wrist flexion and grip strength were significantly greater in group B than group A at 3 months postoperatively. However, wrist ranges of motion, grip strengths, and DASH scores were not significantly different at 1 year postoperatively. Radiographic evaluation demonstrated no intergroup difference in terms of radial inclination, palmar angulation, or ulnar variance at 1 year postoperatively.

Conclusions: Partially healed metaphyseally malaligned healed DRFs had inferior clinical outcomes to acute metaphyseally unstable DRFs in an early postoperative period, however, achieved similar clinical outcomes at 1 year postoperatively when treated using palmar locking plate fixation.