Is dorsal cortex drilling necessary for distal radius fractures treated with a volar locking plate? A comparative study of near-cortex-only and far-cortex drilling.

Abstract

Purpose: This study aimed to compare and analyze the effectiveness of near-cortex-only drilling for the surgical treatment of distal radius fractures using a volar locking plate.

Methods: From January 2010 to December 2022, a total of 185 patients aged 60 years or older with AO type C distal radius fractures who were treated with a volar locking plate at our hospital were enrolled. Of these, 59 patients were excluded according to the study criteria, resulting in a final cohort of 126 subjects. Without differentiating between left and right sides, group A (n=60) underwent distal locking screw fixation with screws of 12-mm length (except for the most radial screw) using near-cortex-only drilling. In group B (n=66), drilling was performed through to the dorsal cortex, and the length was measured using a depth gauge; distal screws were then fixed at a length 2 mm shorter than the measured depth. The degree of fracture reduction on postoperative radiographs was assessed using the modified Lidstrom scoring system by measuring radial inclination, radial height, and volar tilt. In addition, the visual analog scale, the Korean Disabilities of the Arm, Shoulder, and Hand (DASH) score, and the incidence of extensor tendon rupture and tenosynovitis were evaluated at the final follow-up and compared between groups.

Results: Bone union was achieved in all cases, with no significant radiographic differences observed between the two groups (P>0.05). In contrast, two cases of extensor tenosynovitis were noted in group A, whereas group B experienced one extensor tendon rupture and five cases of extensor tenosynovitis, representing a significant difference (P<0.05).

Conclusions: In patients aged 60 years or older with AO type C distal radius fractures, the technique of near-cortex-only drilling with short distal locking screws yielded satisfactory results for fracture reduction and clinical indices. This approach may offer a new alternative for preventing extensor tendon rupture or tenosynovitis.