Evaluating the Safety of Limited Load Bearing for Activities of Daily Living Following Volar Locked Plating of Select Distal Radius Fractures.

Purpose: Distal radius fractures (DRFs) are the most common fractures worldwide. Treatment with open reduction and internal fixation (ORIF) is typically followed by a period of weight-bearing limitations. We hypothesized that (1) allowing patients to load bear for activities of daily living (ADLs) following ORIF of select fracture patterns would not lead to clinically relevant changes in radiographic alignment and (2) a low rate of complications including revision ORIF would be observed.

Methods: A retrospective review of adults (≥18 years old) with DRFs treated with ORIF was identified using Current Procedural Terminology codes. A chart review was performed to identify patients permitted to load bear for ADLs and exclude patients with Arbeitsgemeinschaft für Osteosynthesenfragen classification C3 and A3 fractures (multifragmentary articular and metaphysis, respectively), volar shear fractures (Arbeitsgemeinschaft für Osteosynthesenfragen classification B1-3), volar ulnar corner fractures, and patients with polytrauma or additional ipsilateral injuries. We defined "select patients" as those with fracture types not listed in the exclusion criteria. Radial height, ulnar variance, radial inclination, volar tilt, and intra-articular step-off were measured by two blinded reviewers. Paired equivalence tests were conducted to evaluate differences between intraoperative and postoperative radiographic measurements (using measurement errors from the literature as upper- and lower-limit thresholds).

Results: Of the 66 included patients, mean age was 51 ± 19 years, and 68% (45/66) were women. One patient underwent bilateral ORIF, resulting in 67 cases, of which 17 (25%) were extra-articular, 16 (24%) were two-fragment intra-articular, and 34 (51%) had three intra-articular fragments. No immediate postoperative complications (including implant failure/migration or revision ORIF) were observed within 5 weeks of early load bearing for ADLs.

Conclusions: Limited load bearing for ADLs following ORIF of DRFs with select fracture patterns did not lead to clinically relevant changes in radiographic alignment, loss of reduction, or the need for revision ORIF.

Type of study/level of evidence: Therapeutic IV.