Houston Methodist. Leading Medicine

Wrist FAQ

Question:

What can you tell me about the volar plate system for wrist fractures? Our surgeon is recommending this treatment for Dad to stabilize his wrist fracture. We just don't know anything about it to make an informed decision.

Answer:

The volar plating system is used to treat complex fractures of the distal radius. Distal refers to the farthest end of the bone. The radius is one of the two bones in the forearm that make up one side of the wrist joint. Distal radial (wrist) fractures are far too common in adults over age 65. They can be very disabling, so treatment decisions are important to preserve function. Closed reduction (immobilization with a cast, no surgery) is an acceptable approach when the fracture is non-displaced and stable. In other words, the bone is broken but the broken ends haven't shifted. However, there is come concern about treating older adults with closed reduction. It doesn't realign the bones if they are separated or misaligned. The senior heals (if at all) with what's called a malunion. This can result in stiffness, loss of motion, and decreased functional use of that hand. That's why when the new volar locking plating system came on the market in 2000, more surgeons took advantage of this technique to get a better fracture healing and function in this age group. Volar just refers to the side of the arm the plates are put in (palmer side rather than the back of the hand/wrist side). The plating system is a contoured stainless steel implant that looks like a wrench with multiple holes in the rounded top end and all the way down the stem. It is used when there are complex fractures with multiple bone fragments. The system is laid flat against the bone. Screws can be placed in any of the holes where extra stability is needed. The implant can be slipped under the skin and placed where it's needed, so it's an internal fixation device that doesn't require wide open incision and dissection of all the soft tissues. Studies done so far show the plating system speeds up recovery and reduces the amount of time immobilized. That's important in an age group that is at risk for osteoporosis (brittle bones), joint stiffness, and loss of function and independence with a wrist fracture on top of it. Kevin C. Chung, MD, MS, et al. Trends in the United States in the Treatment of Distal Radial Fractures in the Elderly. In Journal of Bone and Joint Surgery. August 2009. Vol. 91-A. No. 8. Pp.1868-1873.

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