Upsala Journal of Medical Sciences. 2011; 116: 280–284 ORIGINAL ARTICLE Treatment of unstable distal radius fractures with the volar locking plate HANAE MINEGISHI1, OSAMU DOHI1, SOUKAN AN2 & HIDETSUGU SATO3 1Department of Orthopedic Surgery, Tohoku Kosai Hospital, Sendai, Japan, 2Ayashi Orthopedic Clinic, Sendai, Japan, and 3Sato Hidetsugu Orthopedic Clinic, Sendai, Japan Abstract Background. Open reduction and internal ﬁxation using an interlocking plate system has gained popularity for the treatment of dorsally displaced distal radius fractures. Purpose. To evaluate the functional and radiological results of treating unstable distal radius fractures with the volar locking plate. Patients and methods. A retrospective review was conducted of patients from one institution using the volar locking plate to treat intra-articular and extra-articular distal radius fractures. Unstable distal radius fractures in 15 patients, comprising 3 men and 12 women with a mean age of 64.4 years (34–76 years), were treated with a volar locking compression plate (Acu-Loc distal radius plate system; Acumed, Oregon, USA) and followed up for a minimum of 1 year. Fractures were classiﬁed using the AO classiﬁcation. Radiographic parameters of preoperative, postoperative, and ﬁnal follow-up radiographs were compared. The time to initiation of active range of motion was determined. Final follow-up range of motion and complications were reported. Results. At ﬁnal functional assessment, the scores of 5 patients were excellent, 7 patients good, and 3 patients fair according to Cooney’s Clinical Scoring Chart. No non-union or infection occurred. Rupture of the ﬂexor pollicis longus tendon occurred in 1 patient. Conclusion. Treatment of unstable distal radius fractures with a volar locking plate leads to satisfactory results, provided the operative technique is carefully performed to prevent complications. Key words: Complications of locking plate, distal radius fracture, internal ﬁxation, volar locking plate Introduction Open reduction and internal ﬁxation using an inter- locking plate system is a valid treatment of displaced extra-articular and intra-articular distal radius frac- tures in adults (1–4). The goals of treatment are to achieve anatomic fracture union, facilitate early range of motion, and avoid complications. When a dorsal approach is used, extensor tendon rupture and irri- tation caused by implants or surgical intervention are serious complications (5,6,18). Alternative treatment options include bridging external ﬁxation and non- bridging external ﬁxation. A volar approach has been developed to ﬁx a dorsally angulated fracture of the distal radius. It has several advantages, including the broader volar aspect of the distal radius, the avoidance of both dorsal dissection and attendant complications of the extensor tendons, and the possible deprivation of blood supply to the dorsal metaphyseal fragments (7–9). The locking plate and its screws act as a single unit to hold the bone fragments, compared to a traditional plate which needs compression between the plate and the fragment to gain friction. This is particularly useful in the prevention of secondary displacement of the unstable fracture, especially in elderly patients with osteoporotic bones (7,8,10). The purpose of this report is to evaluate the functional and radiological results of treating intra-articular and Correspondence: Osamu Dohi, Department of Orthopedic Surgery, Tohoku Kosai Hospital Sendai 980-0803, Sendai, Japan. Fax: +81-22-263-8069. E-mail: odohi@mbp.nifty.com (Received 23 March 2011; accepted 31 May 2011) ISSN 0300-9734 print/ISSN 2000-1967 online 2011 Informa Healthcare DOI: 10.3109/03009734.2011.594183