A comparative study of clinical and radiological outcomes of dorsally angulated, unstable distal radius fractures in elderly patients: intrafocal pinning versus volar locking plating.
OBJECTIVE
To compare the clinical and radiological outcomes of intrafocal pinning (IFP) and volar locking plating (VLP) of dorsally angulated, unstable distal radius fractures in elderly patients.


METHODS
The subjects were 62 consecutive patients over 60 years of age with dorsally angulated, unstable distal radius fractures treated with IFP or VLP. Bone mineral density (BMD) of the lumbar spine was measured by dual-energy x-ray absorptiometry at first examination. The range of motion and grip strength were measured at follow-up examinations, and ulnar variance (UV) was measured on radiographs at baseline and follow-up postoperative examinations.


RESULTS
There were no notable differences in gender, age, follow-up period, baseline UV, BMD, and AO classification between IFP and VLP groups. There was no difference between the UV in VLP immediately after surgery and at the final follow-up examination; however, IFP showed a significant loss of reduction as measured by UV. In patients with UV more than 5 mm or BMD less than 70% of young adult mean (YAM) at first examination, UV increased again at the final follow-up examination in IFP, while surgically corrected UV was maintained in VLP, independent of the degree of baseline UV and BMD. VLP resulted in earlier recovery of postoperative range of motion and grip strength compared with IFP. The range of flexion and the grip strength value were significantly larger in VLP at final examination.


CONCLUSIONS
VLP, but not IFP, can maintain surgically corrected UV in distal radius fractures, independent of the degrees of initial UV and BMD. VLP enhances earlier recovery in range of motion and grip strength than IFP.


METHODS
Therapeutic II.
Oshige
Toshihisa
T
Department of Orthopaedic Surgery, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan.
Sakai
Akinori
A
Zenke
Yukichi
Y
Moritani
Shiro
S
Nakamura
Toshitaka
T
D000368:Aged; D000369:Aged, 80 and over; D001858:Bone Nails; D001860:Bone Plates; D005260:Female; D005593:Fracture Fixation, Internal / Q000295:instrumentation* / Q000379:methods; D018737:Hand Strength; D006801:Humans; D007593:Joint Instability / Q000601:surgery; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D011859:Radiography; D011885:Radius Fractures / Q000000981:diagnostic imaging* / Q000601:surgery*; D016059:Range of Motion, Articular; D014955:Wrist Joint / Q000601:surgery