Introduction & Aim of the work

1

I ntroduction

Distal radius fractures are the most frequent lesions encountered during
clinical practice. The treatment is controversial and still debated in the literature.
For a correct management of these lesions many authors recently emphasized the
importance of anatomical reduction, a stable fixation and early joint
mobilization.
[1]
In most cases, reduction is easy to achieve but difficult to maintain by closed
means. Tscherne and Jahne
[2]
showed that between 20% and 30% heal with an
unsatisfactory anatomical and functional result, and others have reported a high
incidence of malunion, radial shortening, and articular incongruity with a poor
functional outcome. Surgical methods, which include arthroscopy, plate
osteosynthesis with bone graft, and external fixation, are technically demanding,
may require long periods of postoperative immobilisation and also have high
complication rates.
[3]
Operative treatment for unstable distal radius fractures had gained popularity
recently.
[4]
It enables the maintenance of reduction while allowing early
mobilization and return to function.
[5]
Dorsal comminution, often seen in this group
of fractures, impedes stability and renders their surgical management
challenging.
[6]
Previous biomechanical studies had shown that the greatest degree
of stability in dorsally comminuted distal radial fracture is achieved with internal
fixation by means of dorsally placed plates.
[7]
However, these implants are not
devoid of complications, mainly with regard to extensor tendon irritation.
[8]
While
the use of a volar approach to the distal radius can avoid these complications,
conventional, non-locking volar implants do not provide adequate stability
required for dorsally comminuted fractures.
[7]

Introduction & Aim of the work

2

Locked plating of distal radial fractures is used extensively and there has
been a proliferation of locking plates available for this region. There are
improvements in construct rigidity when locking plates are used compared to
conventional plates and they have been used successfully for this region.
[9]
There
has also been a move towards the use of volar locking plates in dorsally unstable
fractures although complications are starting to be reported and the biomechanical
advantage may lie with dorsal plates.
[10]
Currently, the benefit of a locked volar
plate over a dorsal plate or external fixator remains to be shown.
[11]
Recently introduced volar locking plates had shown promising clinical
results in unstable distal radial fractures.
[5]
Experimental biomechanical evidence
supporting their use with dorsally comminuted unstable distal radius fractures was
recently published.

However supporting clinical evidence for these findings is still
lacking in the literature.
[12]

Aim of the work

The aim of this work is to give a detailed review about the use of locked
plate in management of distal radius fractures. Some selected patients with distal
radial fractures treated with locked plate will be followed up for short term.
Collection of literature from references, papers, articles and internet.