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©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
Screw placement is everything: Risk factors for loss of reduction with volar locking distal radius plates
Herwig Drobetz, Alyce Black, Jonathan Davies, Petra Buttner, Clare Heal
Herwig Drobetz, Alyce Black, Clare Heal, James Cook University School of Medicine and Dentistry, Mackay 4740, Queensland, Australia
Herwig Drobetz, Jonathan Davies, Clare Heal, Mackay Institute of Research and Innovation, Mackay Hospital, Mackay 4740, Queensland, Australia
Herwig Drobetz, Jonathan Davies, Mackay Base Hospital Orthopaedic Department, Mackay Hospital, Mackay 4740, Queensland, Australia
Petra Buttner, Tropical Health Solutions PTY Ltd, Townsville 4810, Queensland, Australia
Petra Buttner, Centre for Chronic Disease Prevention, James Cook University, Cairns 4878, Queensland, Australia
Clare Heal, Anton Breinl Research Centre for Health Systems Strengthening, Townsville 4810, Queensland, Australia
Author contributions: Drobetz H, Black A, Davies J, and Heal C developed the study protocol; Drobetz H, Black A, Davies J initiated the study, and performed literature research and proofreading for scientific content; Drobetz H and Black A participated in patient recruitment and follow-up, data collection, and writing of the manuscript; Heal C performed statistical analysis and interpretation, write up of data, preparation of ethics submission, and provided overall oversight of conduct of study; Buttner P performed statistical analysis of raw data, and revised the manuscript for statistical content.
Institutional review board statement: This study was reviewed and approved by the Human Research Ethics Committee of Queensland Health, Australia.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: All authors declare no conflicts-of-interest related to this article.
Open-Access: This is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Herwig Drobetz, MD, PhD, Professor, Director of Orthopaedics, Department of Orthopaedics, Mackay Hospital and Health District, Bridge Road, Mackay 4740, Queensland, Australia.
herwig.dro@gmail.com
Telephone: +61-748-857900 Fax: +61-748-857900
Received: April 30, 2018
Peer-review started: April 30, 2018
First decision: May 16, 2018
Revised: June 28, 2018
Accepted: August 20, 2018
Article in press: August 21, 2018
Published online: October 18, 2018
Processing time: 171 Days and 5 Hours
AIM
To determine factors correlated with postoperative radial shortening in patients with distal radius fractures treated with volar locking distal radius plates.
METHODS
A total of 250 patients with a distal radius fracture stabilised with volar locking plates between January 2010 and December 2014 were included in a multicentre retrospective cohort study. We measured the distance of the distal locking screws to the joint line immediately postoperatively and then measured radial shortening after six to eight weeks using the change in ulnar variance.
RESULTS
Multivariate linear regression analysis showed that there was a significant linear association between the distance of the screws from the joint line and radial shortening. No other patient, injury, or treatment-related characteristic significantly influenced radial shortening in multivariate analysis.
CONCLUSION
Distal locking screws should be placed as close as possible to the subchondral joint line to prevent postoperative loss of reduction.
Core tip: The aim of this study was to determine risk factors for postoperative radial shortening in patients with distal radius fractures treated with volar locking distal radius plates. Retrospective analysis of 250 X-rays and clinical data determined immediate post-operative distance of the distal locking screws from the joint line and degree of radial shortening 6-8 wk post-operatively. Radial shortening was significantly and linearly correlated with increased distance of locking screws from the joint line. No other factor analysed in the study was significant. We recommend subchondral placement of distal locking screws in order to maintain reduction postoperatively.
