# Functional Outcomes and Early Complications Following Volar Locking Plate Fixation of Unstable Distal Radius Fractures: A Minimum Two-Year Follow-Up Study

## TL;DR

This study shows that volar locking plate fixation for wrist fractures provides good long-term results with minimal major complications.

## Contribution

The study provides long-term clinical outcomes of volar locking plate fixation in Asian populations with unstable distal radius fractures.

## Key findings

- Radiographic alignment improved after surgery and was maintained at two years.
- Patient-reported outcomes, pain, and wrist function improved progressively over time.
- Major complications like nerve injury or tendon rupture were rare, though carpal tunnel symptoms occurred in 17.5% of patients.

## Abstract

Background

Volar locking plate fixation has become the preferred operative treatment for unstable distal radius fractures because it allows stable fixation and early mobilization. However, long-term clinical outcomes and early complications in Asian populations treated in routine practice remain less well documented.

Methods

This retrospective cohort study included 40 consecutive adult patients with unstable distal radius fractures treated with volar locking plates by a single hand and wrist surgeon at a university hospital between January 2012 and December 2021. Patients met predefined radiographic criteria for instability and were followed for at least two years. Radiographic parameters (radial inclination, palmar tilt, and ulnar variance) were assessed preoperatively, immediately after surgery, at three months, and at ≥2 years. Wrist range of motion, grip strength, Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH), Patient-Rated Wrist Evaluation (PRWE), and pain visual analog scale (VAS) scores were recorded preoperatively, at two weeks, three months, and at ≥2 years. Early complications within three months (carpal tunnel syndrome, median nerve palmar branch injury, and extensor pollicis longus rupture) were retrieved from medical records. Paired t-tests were used to compare changes over time.

Results

A total of 40 patients were included (mean age, 55.4 years), of whom 26 (65.0%) were women. Radiographic alignment improved after fixation and was maintained at ≥2 years. Patient-reported outcomes (QuickDASH and PRWE), pain, range of motion, and grip strength improved progressively, with minimal disability and pain at long-term follow-up. Early symptoms consistent with carpal tunnel syndrome occurred in seven (17.5%) patients; no median nerve palmar branch injury, extensor pollicis longus rupture, or flexor pollicis longus rupture was identified.

Conclusions

In this single-surgeon retrospective cohort with a minimum two-year follow-up, volar locking plate fixation for unstable distal radius fractures achieved durable restoration of radiographic alignment and progressive improvement in wrist-related pain and function. Patient-reported outcomes, range of motion, and grip strength improved over time, and major complications were uncommon; early symptoms consistent with carpal tunnel syndrome occurred in seven (17.5%) patients, and no extensor pollicis longus or flexor pollicis longus rupture was identified. Overall, these findings support volar locking plate fixation as a reliable treatment option for unstable distal radius fractures in routine clinical practice.