title: Distal volar radial plates: how anatomical are they?
abstract: BACKGROUND
  Fractures of the distal radius are common, with volar locking plates being increasingly used in their treatment. They aim to provide stable internal fixation and are designed to mirror the natural anatomy. Current volar plate designs incorporate a volar cortical angle (VCA) of 25 degrees.
  
  
  OBJECTIVE
  The aim of this study is to determine whether the VCA in uninjured distal radii corresponds accurately with modern volar plate designs.
  
  
  METHODS
  A retrospective radiological analysis utilizing Computed Tomography scans to assess the VCA of 100 distal radii. Each distal radius was subjected to 3 measurements of the VCA in the sagittal plane.
  
  
  RESULTS
  One hundred patients were identified (67 male, 33 female; mean age 37.4 years). The mean VCA was 32.9 degrees (S.D.±5.14 degrees). The VCA in male patients was significantly greater than in females (33.6 vs 31.5 degrees; P=0.04). There was a statistically significant difference between the lateral VCA and medial VCA (32.2 vs 34.3 degrees, P=0.02).
  
  
  CONCLUSIONS
  Our study clearly demonstrates that the VCA measured in the distal radius is significantly greater than the volar angulation incorporated within modern plate design. Given that the aim of ORIF is to anatomically reconstruct the distal radius, our study highlights that this may not be possible with current plates.
  
  
  METHODS
  Level IV Retrospective case series.
authors.affiliation: Department of Trauma and Orthopaedics, City Hospital, Dudley Road, Birmingham, B18 7QH, United Kingdom. Electronic address: scottevans@nhs.net.
authors.forename: S
authors.initials: S
authors.lastname: Evans
authors.affiliation: Department of Trauma and Orthopaedics, City Hospital, Dudley Road, Birmingham, B18 7QH, United Kingdom; The Royal British Legion Centre for Blast Injury Studies, Imperial College London, South Kensington, London SW7 2BW, United Kingdom.
authors.forename: A
authors.initials: A
authors.lastname: Ramasamy
authors.affiliation: Department of Trauma and Orthopaedics, City Hospital, Dudley Road, Birmingham, B18 7QH, United Kingdom.
authors.forename: S C
authors.initials: SC
authors.lastname: Deshmukh
mesh_terms: D000328:Adult; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D053401:Palmar Plate / Q000033:anatomy & histology*; D011885:Radius Fractures / Q000000981:diagnostic imaging* / Q000601:surgery; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed
keywords: Anatomical reconstruction; Biomechanics; CT; Distal radius fracture; ORIF; Volar locking plates