Volar Locking Plate (VLP) Versus Non-locking Plate (NLP) In The Treatment Of Die-punch Fractures Of The Distal Radius, An Observational Study

Objective: Die-punch fracture of distal radius is a vertical compression fracture of distal radius on the articular surface of Lunate bone.AO/SIF classification used to belong to B3 classification,but now it belongs to B4 type,which is a special type of collapse fracture.At present,there are many controversies in the treatment of Die-punch fracture.The purpose of this study was to investigate whether palmar locking plate(VLP)and non-locking plate(NLP)are superior to non-locking plate(NLP)in the treatment of perforated fractures of distal radius.Methods: The clinical data of 57 cases of distal radius concave fracture were analyzed.There were 32 cases of(NLP)of non-locking plate and 25 cases of(VLP)of palmar locking plate.Preoperative radiography,computed tomography and three-dimensional reconstruction,immediate postoperative radiography,and finally follow-up.Consult the patient’s electronic medical records and record relevant demographic and medical data.The records included palmar tilt,radial inclination,ulnar variation,grip strength,arm,shoulder,hand disability(DASH)and visual analogue scale(VAS)scores and complication.Results: VLP group demonstrated a significantly reduced radial subsidence of 1.5 mm(0.7 versus 2.2 mm),during the interval of bony union(P<0.001),compared to NLP group.Larger proportion of patients(88% versus 62.5%)in VLP group gained acceptable joint congruity(step-off <2 mm)at the final follow-up(P ? 0.037).No significant differences were observed between the groups in the measure-ments of volar tilt,radial inclination,DASH,VAS and grip strength recovery at the last follow-up.There was a trend of fewer overall complications(5/25 versus 10/32)and major complications that required surgery interventions(1/25 versus 4/32)in VLP than NLP groups,although the difference did not approach to significance(P ? 0.339,0.372).Conclusions: VLP leaded to significantly better results of reduction maintainance and the final joint congruity than NLP,while reducing overall and major complications.However,the results should be treated in the context of limitations and the clinical significance of the difference required further studies to investigate.