Osteosynthesis of distal radius using pronator-sparing technique: analysis of the results

The analysis of literature for the last two decades demonstrates active usage of surgical method of treatment for patients with distal radius fractures. At the same time, osteosynthesis of distal radius using volar locking plate via pronator-sparing approach has gain popularity.The aim of the study is to analyze outcomes of volar locking plate osteosynthesis of distal radius fractures using pronator-sparing approach.Material and Methods. We analyzed results of surgical treatment of 226 patients (103 (45,6 %) female and 123 (54,4 %) male) with distal radius fractures treated in the period from 2018 to 2021 using pronator-sparing approach in trauma department of Moscow City Hospital #29 named after N.E. Bauman. The mean age was 39,1±10,6 years (19-58 years). According to D. Fernandez classification system fractures were classified as type I - 174 cases (77 %), type II - 16 cases (7,1 %) and type III - 36 cases (15,9 %). The minimal follow-up after the surgery was 6 months. X-rays and functional results were evaluated from 1 to 6 months after the surgery. The overall results were assessed on the basis of DASH score.Results. Primary union of distal radius was achieved within 6 weeks after the surgery in all cases. At that time the mean X-rays parameters were: volar tilt- 12,01±1,14 degrees, radial height - 12,02±0,89 millimeters, radial inclination - 22,68±1,00 degrees. X-rays results according to Sarmiento-Lidstrom scale were: 183 (81 %) cases - excellent and 43 (19 %) cases - good. There weren’t fair and poor results. In 8 cases (3,5 %) at post-op period there were irritation syndrome of extensor tendons due to perforation of dorsal cortex of distal radius by screws and penetration of extensor compartments. 3 patients (1,3 %) had carpal tunnel syndrome, 1 (0,4 %) had peri-implant fracture of distal radius and 1 (0,4 %) - early superficial wound infection. After 6 months 95,1 % ofpatients had an excellent and good results, 4,4 % - fair. 1 patient (0,4 %) despite fracture union was disappointed that functional result was not as he expected. Conclusions. The use of pronator-sparing approach for volar locking plating of distal radius fractures demonstrates excellent clinical results and seems to be more than real and effective instrument to improve treatment results.