Distal radius fractures are most common fractures accounting for 17.5% of all adult fractures⁽¹⁾. Also distal radius fractures account for 20%fracturestreated in the emergency departments⁽²⁾. These fractures have a bimodal distribution with first peak in 5-24yrs old mainly in male population who are mostly athletic and high energy injuries andsecond peak in elderly mainly in females⁽³⁾. Average age for distal radius fractures in adults for females in their 60s and men in their 40s⁽¹⁾.

Majority of fractures are extra-articular. Risk factors for distal radius fractures are female gender, early menopause, decreased bone mineral density. Majority are treated with plaster of paris cast after closed reduction under local anesthesia. ⁴

Distal radius fractures can be treated with ample number of surgical options. These include closed reduction and percutaneous pinning, external fixation, open reductionand internal fixation with volar locking plates and dorsal locking plates, intra medullary fixation as well as arthroscopic reduction and fixation. ORIF of distal radius fractures has become increasingly popular in recent years, particularly in relation to the use of volar locking plates. ^5,6 Combined approaches may be indicated for complex intra articular distal radius fractures. Aims of treatment are to restore anatomy, to aim for minimal loss of reduction and to restore functional ability after treatment as soon as possible.

AIM

To study results of distal radius intra-articular fractures managed by using volar locking and non locking plate by Flexor carpi radial is approach and Prof. Vasudhevan 5 K wire technique.

OBJECTIVES

1. To compare efficacy of volar plate (locking and non- locking) and k wires to attain radiological reduction and stability of attained reduction till union
2. To compare the differences in functional outcome of both groups
3. To compare postoperative complications in both groups

This was a prospective study conducted during the period of 2020 to 2021in Department of Orthopaedics, Govt General Hospital, Ananthapur. Cases with Distal Radius Intraarticular fractures were admitted and evaluated clinically and radiologically. Consent was obtained from each patient, and ethical clearance was obtained from institutional ethical committee.

Sample size

A total of 30 cases were enrolled in the study.

Inclusion criteria

Age group:>18years

Gender: Males and Females

Cases of Distal Radius Intraarticular Fractures Patients who are willing to participate in the study Patients fit for surgery

Exclusion criteria

Children and adolescent patients <18yrs Compound fractures

Acute infections

Pathological fracture

Fractures associated with neurovascular deficits Patients not willing for surgery

Preop Assessmet and Data Collection

Patients who were presented within trarticular distal radius fractures to OPD and casualty within the age group >18years were included in study. Demographic information such as Name, age, sex, address, details of injury, occupation, current job status were obtained through an interview. Detailed history of patient including mode of initial injury, initial treatment taken.

Pain was documented using a visual analogue scale, Range of mobility was documented around the wrist. dorsiflexion, palmar flexion, Supination &pronation around the wrist were documented & Type of deformity was noted comparing to opposite side.

Investigations

Patient was subjected to an array of haematological investigations, Chest X-ray PA view, Electrocardiogram, 2D Echocardiography was done. After the completion of investigations a pre anaesthetic check up was performed by the anaesthesiologist and the patient was planned for the surgery electively. Preparation of the part was done on the day of surgery. Tetanus toxoid injection and Injection lignocaine sensitivity was performed pre operatively.

Position and Preperation

Prophylactic preoperative intravenous antibiotic was given to patients one hour before the surgery. After giving anesthesia patient was placed in supine position with arm placed on the radiolucent side table. Operating limb was exsanguinated for 3 minutes and mid arm Esmarch rubber bandage was applied. Forearm and hand were thoroughly scrubbed with betadine and spirit. After painting the limb with betadine, limb was thoroughly draped and placed on radiolucent table.

Half the cases were treated with Volar Locking or non-locking Plate using Flexor carpi radials Approach and the other half cases were treated by 5 K-Wire P.N.Vasudhevan technique.

K WIRE Technique ⁽⁷⁾

After positioning the patient and preparation of surgical site, under fluoroscopy after

Reducing the fracture by manipulating with traction and countertraction,

First k wire was inserted from distalulna proximal to the fracture such that it was

Directed towards the radialstyloid process and passing justproximaltothedistal

Radioulnar joint.

Second K Wire was inserted from distaltoproximally from the tip of styloid process

With an angle of 45 degrees oblique to long axis radius in both AP and Lateral planes to

Get hold at the proximal radial cortex.

Third K Wire placed from dorsal to volar side .K wire was passed lateral to the listers

Tubercle to engage the volar cortex of proximal radius.

Fourth K Wire fixed from the dorso-ulnar corner of distal radius to lateral cortex of proximal radius.

Fifth K Wire pierced from the ulnar shaft proximal to the fracture and engaged in proximal radius both cortices in mid-prone position. elow elbows lab is applied postoperatively.

Patients follow-up was done at 3 weeks, SIX weeks, 3 Months, 6 months,8 months. At each visit patients were assessed clinically, radiologically and complications were noted.

Assessment at first week – for pain & Assessment at 6 weeks-for pain and Range of motion & Assessment at 3 months – for pain, Range of motion , clinical and radiological assessment of union. Assessment at 6 months – for pain, clinical and radiological assessment of union, activities of daily living.

FUNCTIONALEVALUATION

Demerit point System-Gartland & Werley with Sarmiento et al.

Modification ⁽⁸⁾.

The objective evaluation isbased on the following ROM as being minimum for normal function. Dorsiflexion–45 degrees,Palmar fexion–30 degrees, Radial Deviation–15 degrees, Ulnar Deviation–15 degrees,Pronation–50 degrees and Supination–50 degrees.

The present study comprises 30 cases of intra-articular distal radius fractures treated at the Government General Hospital, Ananthapuramu, during the period from November 2019 to November 2021. All cases were followed up periodically at 3 weeks, 6 weeks, 3 months, 6 months, and 8 months. The results were evaluated at the end of the study period. Anatomical analysis was conducted using Sarmiento's scoring, while functional analysis was assessed with the Gartland & Werley Functional Score at the 6-month follow-up. The data were analyzed, and observations were systematically tabulated. Both the volar plating and K-wire fixation groups were compared based on demographic characteristics such as age distribution, gender, occupation, and mechanism of injury.

GENDER DISTRIBUTION ACCORDING TO THE PROCEDURE

Table 1. Gender Distribution According to The Procedure in Our

Study

SIDE INVOLVEMENT

The LEFT side is predominantly involved with 19 (63.33%) cases than Right side with 11 (36.6%) cases in our study.

Table 2. Side Involvement In Our Study

MODE OF INITIAL INJURY

The common mechanism of injury in this study was Road traffic accident with

19(63.33%) cases than F all on out stretched hand with 11(36.6%) cases.

Table 3: Mode Of Initial Injury In Our Study

ASSOCIATED FRACTURES

In our study one case is associated with fracture of ipsilateral humerus middle third

shaft.

Table 4: Associated Fractures In Our Study

CASES AS PER FRYKMANN CLASSIFICATION

In this study majority of cases belong to frykmann type8, 18 (60%) cases belong to type 8.

Table 5: Cases As Per Frykmann Classification in Our Study

CASES AS PER AO CLASSIFICATION

Majority of our cases of about14 (46.66%) belong to type C1 of AO classification.

Table 6: Cases As Per Ao Classification In Our Study

DURATION OF SURGERY

In our study mean duration of surgery ranges from 40-80 minutes for plating and 30-40 mins for k wire fixation distal end radius fractures. Mean duration of surgey for plate fixation is 63.67 minutes and for k wire fixation 36.00 minutes with t=8.784 and p value= 0.000 which is statically significant.

Table 7: Duration Of Surgery In Our Study

TIME FOR UNION

Table no.8–TIME FOR UNION

Mean duration for union in plating group – 7.87 weeks and in plating group – 8.53 weeks with t = -1.538 and p value = 0.135 which is not significant.

COMPLICATIONS

Table 9–Complications In This Present Study

SARMIENTO'S MODIICATION OF LINDSTROM CRITERA

RESIDUAL DEFORMITY- In our study according to sarmientos modification of

Lindstrom criteria for residual deformity17 (56.6%) cases have excellent results,12

(40%) cases have good outcome, 1(3.33%) case has fair outcome and none of the

Cases have poor outcome.

LOSS OF PALMARTILT

In our study according to sarmientos modification of lindstrom criteria for loss of palmartilt4 (13.3%) cases have excellent results, 22 (73.33%) cases have good outcome , 4(13.33%) case has fair outcome and none of the cases have poor outcome.

Table10: Loss Of Palmartilt

Table11: Anatomical Outcome According To Sarmiento’s Criteria

Subjective Evaluation–

In our study according to GARTLAND & WERLEY SCORING SYSTEM at the end of follow-up 3 (20%) of cases in plating group, 3 (20%) of cases in K wire group have Excellent outcome , 11(73.3%) cases in plating group and 10(66.6%) cases in k wire group have Good outcome. 1(6.6%) case in plating group and 1(6.6%) case I k wire group have Fair outcome. 0 cases in plating group and 1(6.6%) in k wire group have Poor outcome. Subjective Evaluation

In our study according to the GARTLAND& WERLEY SCORING SYSTEM at the end of follow-up 14 (94.1%) cases have Excellent outcome, 1(5.9%) case have Good outcome and no cases with fair or poor outcome in PLATING group. 12(80%) cases have Excellent outcome, 1case have Good outcome ,2(13.3%) cases have Fair outcome and none have poor outcome in K Wire group. With Fishers exact=1.154andPvalue= 0.598 which is not significant and with this study both produres gives good functional outcome.

Table12: Gartland and Werley Functional Score

Case- 11

Distalend radius bone fractures are one of the most common upper limb fractures. Early diagnosis and management give good outcome and prevents disabiling complications. The present study consists of 30 cases of intra-articular Distal Radius fractures treated in Government General Hospital Ananthapuramu during the period between November 2019to November 2021.

AGE INCIDENCE: In the present study age of patients ranges from 18 – 60 years, with Over-all mean age of 47.06 years. Mean age in plating group is 45.60 years and mean age in k wire fixation group is 48.53 years with more incidence of fractures in 4^th and 5^th decades and p value = 0.583

Jahangir Iqbal Khan⁽⁹⁾-Mean age of patients in k wire fixation group and plating group was 36.13±9.81 and 44.73±7.86 years respectively.

SIDE INVOLVEMENT: The LEFT side is predominantly involved with19(63.33%) cases than Right side with 11 (36.6%) cases in this study. Jahangir Iqbal Khan⁽⁹⁾- in this study right side in 11 cases and 19 cases were left sided. Huseyin Yetkin⁽¹⁰⁾– in this study 16 were left sided and 14 were right sided. H. C. Lee⁽¹¹⁾ - There were 11 right and 11 left.

MODE OF THE INITIAL INJURY :The common mechanism of injury in this study was Road traffic accident with 19 (63.33%) cases than Fall on out stretchedh and with11 (36.6%) cases. 60%ofcases from plating goup and 66.66% of cases from k wire fixation group are due to road traffic accidents. Jahangir Iqbal Khan⁽⁹⁾-out of 30 cases 20 cases due to road traffic accidents and 10 case trauma due to fall from height.

FOLLOWUP PERIOD – Post operative follow-up in this study ranges from 3.5 months to 18 months with mean follow-up of 8.7 months.

Jahangir Iqbal Khan⁽⁹⁾- Post operative follow up was done for 12 weeks. Huseyin Yetkin⁽¹⁰⁾- The mean duration of follow up was 17.5 months (range, 12-50) .

ANATOMICAL OUTCOME–In our study according to sarmientos modification of lindstrom criteria 7cases (46.66%) showed excellent,7(46.66%) cases showed good, 1 (6.6%)case showed fair out come in plating group. 8 (53.33%) cases showed excellent , 6 (40.00%) cases showed good , 1 (6.6%)case showed fair out come in k wire fixation group .Overall 17 (56.6%) cases have excellent results, 12 (40%) cases have good outcome,1 (3.33%) case has fair outcome, no cases have poor outcome with P value=1.000. With mean values of Radial Length–10.20mm, Radial inclination – 21°, volar tilt – 9.3°.

FUNCTIONAL OUTCOME – In this study at end of followup14(94.1%) cases have Excellent outcome, 1(5.9%) case have Good outcome and no cases with fair or poor outcome in PLATING group.12 (80%) cases have Excellent outcome,1casehave Good outcome ,2(13.3%) cases have Fair outcome and none have poor outcome in K Wire group. P value= 0.598 which is not significant and with this study both procedures gives good functional outcome.

HuseyinYetkin⁽¹⁰⁾-Gartland-Werley score outcome found to be excellent in11 patients (73.3%) and good in 4 patients (26.7%) in plating group and excellent in seven patients (46.6%),good in seven patients (46.6%) and moderate in one patient (6.8%)I n k wire group and concluded that over all outcome was good in plating.

RANGE OF MOTIONS : At end of follow up mean wrist motion is 58.7° of extension (range, 46–85°), 53.4° of flexion (range, 40–80°), 29.6° of ulnar deviation (range, 19–40°), 14° of radial deviation (range, 10–26°), 79° of pronation (range, 60–90°), and 74.7° of supination (range, 30–90°) in plating group. Mean values in k wire fixation group are 56.7degrees of extension, 52.4 degrees of flexion, 25.5 degrees ulnar deviation , 14.5 degrees radial deviation,76degrees pronation and 73.4degrees of supination, with no significant difference in functional outcome in both groups.

HuseyinYetkin⁽¹⁰⁾- in this study mean range of follow up was better in plating group than k wire group.

COMPLICATIONS: In this study complications like post op residual pain was seen in 3 cases from plating groups and 3 cases from k wire fixation group which was gradually relieved with analgasics.

Based on experience from this study we conclude that VOLAR PLATE fixation and 5 K wire fixation are reliable methods for the treatment of intraarticular distal radius fractures both volar plating and 5 k wire fixation are reliable and effective means. The present study portraits that though age, sex, mechanism of injury, type of fracture and comminution are different both 5 K wire fixation and volar plating have good efficacy with similar radiological and functional outcomes.

Conflict of Interest: None

Funding Support: None

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