European Journal of Cardiovascular Medicine

Distal radius fractures are among the most frequent osteoporotic fractures in the elderly population, often resulting from low-energy falls onto an outstretched hand (1). These fractures can significantly impair wrist function, particularly when they involve the articular surface, making restoration of anatomy and function a critical goal in treatment (2). The management of intra-articular distal radius fractures in elderly patients is particularly challenging due to the compromised bone quality and the presence of comorbidities that can delay recovery (3).

Historically, conservative treatments such as casting and closed reduction were widely employed, especially in older adults. However, these methods have often been associated with loss of reduction, malunion, and prolonged immobilization, which may result in poor functional outcomes (4). With the advent of advanced internal fixation techniques, volar locking plate (VLP) fixation has emerged as a preferred surgical approach for these fractures, offering stable fixation even in osteoporotic bone and allowing early mobilization (5).

VLP systems provide angular stability and improved load distribution, which are advantageous in comminuted and intra-articular fracture patterns. Several studies have reported improved anatomical alignment and early return to function with VLP fixation, even in the elderly cohort (6,7). Moreover, early surgical intervention has been shown to reduce the duration of disability and improve quality of life in this age group (8).

Despite the growing adoption of VLPs in elderly fracture management, there remains variability in outcomes based on patient factors, fracture characteristics, and surgical techniques. Therefore, it is essential to assess both functional recovery and radiological healing to determine the true efficacy of VLP fixation in elderly patients with intra-articular distal radius fractures (9,10).

The study included 40 elderly patients aged 60 years and above who presented with intra-articular distal radius fractures and were managed with volar locking plate fixation.

Inclusion Criteria:

• Patients aged ≥60 years
• Radiographically confirmed intra-articular distal radius fractures (AO Type C)
• Fractures treated with open reduction and internal fixation using a volar locking plate
• Willingness to participate and comply with follow-up

Exclusion Criteria:

• Open fractures of the distal radius
• Polytrauma cases
• Previous wrist injury or surgery
• Associated neurovascular deficits
• Pathological fractures

Surgical Procedure:
All procedures were performed under regional or general anesthesia using the standard modified Henry’s approach. The fracture fragments were reduced under fluoroscopic guidance, and fixation was done using a pre-contoured titanium volar locking plate. Intraoperative C-arm imaging was used to confirm proper placement of screws and restoration of radial height, inclination, and volar tilt. A short volar splint was applied postoperatively and removed after 2 weeks to allow early physiotherapy.

Postoperative Protocol and Follow-Up:
Patients were followed up at 6 weeks, 3 months, and 6 months postoperatively. Clinical outcomes were assessed using the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. Radiographic evaluation was performed to measure radial inclination, radial height, and volar tilt using standard anteroposterior and lateral wrist X-rays. Any complications such as infection, implant failure, or stiffness were also documented.

Statistical Analysis:
Descriptive statistics were used to summarize patient demographics and outcome variables. The paired t-test was employed to analyze changes in DASH scores and radiographic parameters over time. A p-value of less than 0.05 was considered statistically significant. Data analysis was performed using SPSS version 26.0 (IBM Corp., Armonk, NY, USA).

A total of 40 elderly patients (24 females and 16 males) with intra-articular distal radius fractures were included in the study. The mean age was 67.3 ± 5.6 years. All patients underwent volar locking plate fixation and completed the 6-month follow-up period.

Functional Outcome:
The mean Disabilities of the Arm, Shoulder and Hand (DASH) scores progressively decreased over time, indicating significant improvement in upper limb function. The mean DASH score at 6 weeks was 78.5 ± 6.4, which reduced to 38.2 ± 5.1 at 3 months and further to 18.2 ± 4.7 at 6 months. The change was statistically significant (p < 0.001) (Table 1).

Table 1: DASH Scores Over Time

Radiological Outcome:
Radiographic assessment showed maintained anatomical alignment throughout follow-up. At the final visit, the mean radial inclination was 21.6° ± 2.3, volar tilt was 10.2° ± 1.5, and radial height was 11.8 ± 1.1 mm. There were no cases of loss of reduction or implant displacement (Table 2).

Table 2: Radiographic Parameters at Final Follow-Up (6 Months)

Complications:
Minor complications were observed in 6 patients. Four patients reported mild wrist stiffness, while two experienced transient median nerve paresthesia, which resolved within 4 weeks. No cases of deep infection, implant loosening, or tendon irritation were reported (Table 3).

Table 3: Complications Observed

Patient Satisfaction:
At the final follow-up, 85% (34 out of 40) of patients reported high satisfaction with pain relief and function, based on subjective scoring. Six patients expressed moderate satisfaction due to limited range of motion (Table 4).

Table 4: Patient Satisfaction at 6 Months

These results support the effectiveness of volar locking plate fixation in restoring function and achieving radiological alignment in elderly patients with intra-articular distal radius fractures.

Distal radius fractures are prevalent among the elderly due to osteoporotic bone and reduced protective reflexes during falls. Managing intra-articular variants in this demographic remains a challenge due to compromised bone quality and high functional demands. Volar locking plate (VLP) fixation has emerged as a reliable treatment modality, offering both biomechanical stability and the possibility of early mobilization (1,2).

In the present study, the mean DASH score improved significantly over the 6-month follow-up, from 78.5 at 6 weeks to 18.2 at final evaluation. This finding is consistent with prior studies demonstrating superior functional outcomes using volar locking plates in elderly patients with complex distal radius fractures (3,4). The ability of VLPs to maintain reduction even in osteoporotic bone enables earlier rehabilitation and better hand function, which is critical in this age group (5).

Radiological parameters in our study revealed that anatomical alignment was maintained throughout follow-up. The mean radial inclination, volar tilt, and radial height at final evaluation were within acceptable ranges, similar to findings reported by Arora et al. and Orbay et al., where the majority of cases achieved satisfactory radiographic outcomes (6,7). The locking mechanism of the plate, coupled with angular stability, prevents collapse and supports consistent bone healing (8).

Our complication rate was low, with only minor issues such as mild stiffness and transient paresthesia, which resolved conservatively. This is in alignment with other clinical studies that have shown low rates of tendon irritation, infection, or implant-related failures when VLP fixation is used judiciously (9,10). In contrast, conservative treatment in elderly patients has often been associated with malunion, prolonged disability, and decreased patient satisfaction (11).

The high satisfaction rate in this study (85%) further supports the efficacy of this intervention. Patients were able to resume daily activities relatively early, an outcome especially important in elderly populations where prolonged immobility can lead to complications such as muscle atrophy, joint stiffness, or thromboembolic events (12).

Some literature advocates for nonoperative management in selected low-demand elderly patients due to surgical risks and costs (13). However, growing evidence—including this study—suggests that operative fixation with volar plates leads to faster functional recovery, improved radiological alignment, and enhanced patient-reported outcomes (14,15).

Limitations of this study include the relatively small sample size and short follow-up duration. Additionally, the study lacked a control group treated nonoperatively, which would have strengthened the comparative validity of the findings. Future randomized controlled trials with larger populations and longer follow-up are needed to further confirm these observations.

Volar locking plate fixation in elderly patients with intra-articular distal radius fractures provides excellent functional recovery, stable radiological alignment, and a low complication rate. It is a reliable option that promotes early mobilization and high patient satisfaction.

1. Quadlbauer S, Pezzei C, Jurkowitsch J, Rosenauer R, Pichler A, Schättin S, et al. Functional and radiological outcome of distal radius fractures stabilized by volar-locking plate with a minimum follow-up of 1 year. Arch Orthop Trauma Surg. 2020;140(6):843-52. doi:10.1007/s00402-020-03411-9.
2. Quadlbauer S, Pezzei C, Jurkowitsch J, Rosenauer R, Pichler A, Schättin S, et al. Early complications and radiological outcome after distal radius fractures stabilized by volar angular stable locking plate. Arch Orthop Trauma Surg. 2018;138(12):1773-82. doi:10.1007/s00402-018-3051-5.
3. Quadlbauer S, Pezzei C, Jurkowitsch J, Kolmayr B, Simon D, Rosenauer R, et al. Immediate mobilization of distal radius fractures stabilized by volar locking plate results in a better short-term outcome than a five week immobilization: A prospective randomized trial. Clin Rehabil. 2022;36(1):69-86. doi:10.1177/02692155211036674.
4. Perugia D, Guzzini M, Mazza D, Iorio C, Civitenga C, Ferretti A. Comparison between Carbon-Peek volar locking plates and titanium volar locking plates in the treatment of distal radius fractures. Injury. 2017;48(Suppl 3):S24-9. doi:10.1016/S0020-1383(17)30653-8.
5. García-Cepeda I, Aguado-Maestro I, De Blas-Sanz I, Quintanilla-García A, García-Alonso M. Radiological results of surgical management of fracture of the distal radius treated with volar locking plates. Injury. 2020;51(Suppl 1):S42-7. doi:10.1016/j.injury.2020.02.106.
6. Arora R, Lutz M, Hennerbichler A, Krappinger D, Espen D, Gabl M. Complications following internal fixation of unstable distal radius fracture with a palmar locking-plate. J Orthop Trauma. 2007;21(5):316-22. doi:10.1097/BOT.0b013e318059b993.
7. Südow H, Severin S, Wilcke M, Saving J, Sköldenberg O, Navarro CM. Non-operative treatment or volar locking plate fixation for dorsally displaced distal radius fractures in patients over 70 years: A three year follow-up of a randomized controlled trial. BMC Musculoskelet Disord. 2022;23(1):447. doi:10.1186/s12891-022-05394-7.
8. Cheng MF, Chiang CC, Lin CC, Chang MC, Wang CS. Loss of radial height in extra-articular distal radial fracture following volar locking plate fixation. Orthop Traumatol Surg Res. 2021;107(5):102842. doi:10.1016/j.otsr.2021.102842.
9. Zengin EC, Ozcan C, Aslan C, Bulut T, Sener M. Cast immobilization versus volar locking plate fixation of AO type C distal radial fractures in patients aged 60 years and older. Acta Orthop Traumatol Turc. 2019;53(1):15-8. doi:10.1016/j.aott.2018.10.005.
10. Bae JY, Yoon JO, Choi SW, Kim JK. Comparison of outcomes between partially healed and acute metaphyseally malaligned distal radial fracture treated by palmar locking plate fixation. J Orthop Sci. 2017;22(6):1049-53. doi:10.1016/j.jos.2017.08.007.
11. Dario P, Matteo G, Carolina C, Marco G, Cristina D, Daniele F, et al. Is it really necessary to restore radial anatomic parameters after distal radius fractures? Injury. 2014;45(Suppl 6):S21-6. doi:10.1016/j.injury.2014.10.018.
12. Gereli A, Nalbantoğlu U, Kocaoğlu B, Türkmen M. Comparison of palmar locking plate and K-wire augmented external fixation for intra-articular and comminuted distal radius fractures. Acta Orthop Traumatol Turc. 2010;44(3):212-9. doi:10.3944/AOTT.2010.2325.
13. Williksen JH, Frihagen F, Hellund JC, Kvernmo HD, Husby T. Volar locking plates versus external fixation and adjuvant pin fixation in unstable distal radius fractures: a randomized, controlled study. J Hand Surg Am. 2013;38(8):1469-76. doi:10.1016/j.jhsa.2013.04.039.
14. Lee JK, Lee SH, Sim YS, Kim TH, Baek E, Han SH. Juxta-articular plate fixation in distal radius intra-articular fractures with accompanying volar free fragments beyond the watershed line. Clin Orthop Surg. 2018;10(2):135-41. doi:10.4055/cios.2018.10.2.135.
15. Abe Y. Plate presetting and arthroscopic reduction technique (PART) for treatment of distal radius fractures. Handchir Mikrochir Plast Chir. 2014;46(5):278-85. doi:10.1055/s-0034-1387705.