Functional and Radiological Outcome of Closed Distal Radius Fractures (AO Type B & C) Treated Operatively in Adults - A Long Term Retrospective Observational Study

Intra articular DRF’s are unstable, difficult to reduce anatomically, and often associated with complications. Literature regarding functional outcomes of intra articular DRF’s specifically AO type B and C with are lacking. Our study was designed to evaluate functional and radiological outcomes of surgically treated adult, closed, intra articular DRF’s by comparison between different surgical fixation methods i.e External Fixator with or without supplemental K wires and Plate fixation (i.e volar / dorsal / combined). 

We included patients with intra articular DRF’s admitted for operative fixation between 2014 and 2022. Medical records and radiographic images were reviewed after institutional research board clearance. Demographic data, including age, gender, and handedness, were recorded. Preoperative information like mechanism of injury, AO classification, and associated injuries was noted along with Intraoperative details, implants used, and complications. Data of 240 patients with DRF were retrieved from operation theatre records, of which 145 patients were AO type B and C. Excluding those lost to follow up or those without required radiographic images, a final cohort of 116 patients remained in our study. Post-operative functional outcome was assessed using Mayo wrist score, patient rated wrist evaluation (PRWE), Quick DASH, dynamometer measurement of Pinch & Grip strength. Radiographic evaluation (preoperative and postoperative) was done using Sarmiento’s modification of Lindstrom criteria. Patients were followed up at 6, 12 and 52 weeks after surgery and data collected was analysed.   

The 116 cases were organised into 4 groups, based on the type of treatment provided i.e {Closed reduction + external Fixator (EF), volar plating (P v), dorsal plating(P d), and combined dorsal & volar plating(P v+d )}. All fractures united. The parameters of ulnar variance, radial inclination, radial tilt, and radial height became equal to the unaffected side. The mean grip strength of the operated side at 1 year was 50.78+_9.07 % of the normal side. The mean Q-DASH, MAYO wrist score, PRWE improvement at 1 year were 6.8 +_ 6.8, 78.19 +_8.1 and 30.33 +_17.05 respectively. According to the Lidstrom Sarmiento criteria, the results were excellent in 88 patients (75.8%), good in 28 patients (24.1%), and none had fair or poor results. Two minor complications (1.7%) were noted. 

Our study demonstrated significant improvements in functional outcomes, following operative treatment for closed intra-articular DRF’s (AO Type B & C) in adults. Radiological outcomes, indicated good fracture alignment & joint congruity. Although no significant differences were found in grip strength, motion, or functional scores between the volar plating and External Fixator groups at 12 months, the plating group showed superior short-term results for functional recovery. The plating group also showed superior radiological outcome in terms of the ulnar variance, but this outcome was not significant at 12 months.

Keywords: intra articular distal radius fractures, External fixation, Volar plating, Dorsal plating