Complication Rate Comparing Variable Angle Distal Locking Plate to Fixed Angle Plate Fixation of Distal Radius Fractures.

BACKGROUND: Distal radius fractures are common, accounting for approximately 18% of all fractures in adults. Operative management is common, and there are numerous variants of plates used. However, data on safety and complication rates for different plates are limited.

OBJECTIVE: To determine whether the rate of complications differed between two distinct types of volar plate design for distal radius fracture fixation, one using predetermined fixed angles for the locking screws or pegs and the other using a variable angle locking design for the locking screws or pegs. Our null hypothesis was that the rate of complications would be the same in each group.

MATERIALS AND METHODS: A retrospective chart review was performed on patients with unstable distal radius fractures treated operatively between 2008 and 2011. Patients treated with external fixation or small fragment plates were excluded; all remaining patients underwent internal fixation with 1 of 3 plate designs: Stryker Universal Distal Radius Plate, Acumed Acu-Loc, or Trimed Volar Bearing Plate.

RESULTS: A total of 189 patients underwent surgical treatment for an unstable distal radius fracture with a volar plate. Fixed angle plates were used in 60 patients and polyaxial locking plates using a rotatable bearing were used in 148 patients. In the fixed angle plate group, 11 required a second operation on the affected limb for a total of 18 procedures. In 7 of 11 patients, secondary surgery was directly related to complications from the hardware (symptomatic hardware, loose hardware and tendon rupture). All 7 of these patients were in the fixed angle plate group, for a rate of hardware related complications of 12% (7/60). No hardware related complications occurred in patients in the group treated with a polyaxial locking plate (0/129). The complication rate in the fixed angle plate group is significantly different than 0, the rate observed in the polyaxial locking plate group (z score = 3.95, P < 0.001).

CONCLUSIONS: Our data suggest that treatment of unstable distal radius fractures with a volar bearing variable angle plate fixation is safe and effective. In our series, there was a significant reduction in the rate of hardware-related complications with the polyaxial locking plate as compared with a fixed angle plate.Therapeutic, Level III, retrospective comparative study.