The effect of proximal cortical screw length of volar locking plates on clinical outcomes in distal radius fractures.

Abstract

Objective: To evaluate the impact of proximal cortical screw length in volar locking plates (VLPs) on clinical outcomes in patients with distal radius fractures (DRFs). Study Design: Prospective observational study. Setting: Department of Orthopedic Surgery, Nishtar Hospital, Multan, Pakistan. Period: June 2024 to April 2025. Methods: We enrolled 104 patients aged ≥18 years with DRFs treated with VLPs, followed for at least 12 months. Exclusion criteria included prior limb injuries, open fractures, non-VLP interventions, and extensor soreness from distal screws. Clinical outcomes, including grip strength (Jamar dynamometer), range of motion (ROM), Quick Disabilities of the Arm, Shoulder, and Hand (QDASH) scores, and extensor tendon complications, were assessed. Radiological evaluations measured dorsal cortical screw prominence (>1.2 mm) using postoperative X-rays. Surgical procedures used a Colar Henry incision and Acu-Loc VLP with unicortical distal and bicortical proximal screws. Data were analyzed using SPSS 26.0, with Mann-Whitney U and chi-square tests for non-normally distributed continuous and categorical variables, respectively. Results: Of 104 patients (63 males, 60.6%; mean age 49.13 years), 61 (58.7%) had right-sided fractures, primarily caused by road traffic accidents. Extensor sensitivity occurred in 36 (34.6%) cases. Proximal screw prominence >1.2 mm was significantly associated with extensor synovitis (p<0.05), but not with grip strength, ROM, or QDASH scores. Patient satisfaction was 50.96% (53/104). Conclusion: Proximal cortical screw prominence >1.2 mm in VLPs significantly increases extensor tendon irritation in DRFs, emphasizing the need for precise screw length to optimize clinical outcomes and patient satisfaction.