An anteroposterior ridge divides the articular surface into a triangular lateral facet and quadrilateral medial facet, which articulates with the scaphoid and the lunate respectively. The medial surface of the distal radius articulates with the ulna head with its semicircular notch. This enables the radius to swing around its axis, the ulna[1]. The prominent styloid process is the main part of the flaring lateral process and it is the attachment to the brachioradialis muscle.

The distal radius interacts with the proximal surfaces of the scaphoid and lunate through the scaphoid fossa and the lunate fossa. The triangular scaphoid fossa points radially, and is much larger than the more quadrangular lunate fossa, which is located on the ulnar side of the radius[2].

The metaphysis flares distally in both the anteroposterior and the lateral planes with a dorsally and radially lying thinner cortical bone. The thin cortices are clinically significant because the fractures typically tend to collapse in the dorsoradial direction[3].

There are many unsatisfactory results in the treatment of fractures of the distal end radius. By plaster cast method, deformity in about 60% of patients and unsatisfactory results in 32% of the patients are seen[4]. Recent advances in evaluation of fracture patterns and results of treatment have demonstrated the need for surgical intervention in fractures demonstrating instability with or without articular incongruity[5-6].

Distal radial fractures with dorsal angulation are common and tend to suffer secondary displacement after conservative treatment. Distal radius is important in kinematics of radio-carpal and radio-ulnar joints therefore reconstruction of articular congruity and restoration of the radial length, volar angulation and radial inclination are the prerequisite for good clinical outcome[7].

The degree of disability after distal radius fracture has been seen to correlate with the amount of residual deformity[8]. Many treatment options for obtaining acceptable alignment in these injuries have been described. Close reduction and cast immobilization used to be the mainstay of treatment of the fractures of the distal radius[9-10]. Various methods for maintaining the reduction with additional fixation are being used like Kirschner wire, bridging and non-bridging external fixation, open reduction and internal fixation with dynamic compression plate and fixed angle/ variable angle locking plates and arthroscopic assisted reduction techniques[11].

Jayarogya Group of Hospitals, G.R. Medical College, Gwalior, A Total number of 60 patients were selected (30 from each group) from outpatient department and trauma center. Fracture pattern included for study will be extra-articular fracture distal end of Radius. Selection based on some inclusion and exclusion criteria.

In this study we used Modified Henry‟s Approach. It is suitable for most distal radial fractures. This approach use the plane between flexor carpi radialis (FCR) tendon and the radial artery, i.e., ulnar to the radial artery. The classical Henry approach uses the plane between brachioradialis and the radial artery, i.e., radial to the radial artery. During modified Henry approach, radial artery and the palmar branch of the median nerve are at risk of injury.

Inclusion criteria

• Patients with radiologically confirmed Extra-articular fracture distal end of radius
• Patients age > 18 years
• Medically fit patients
• Closed fracture and Compound fracture G.A. I
• History of trauma <10 days
• Patient giving consent for examination and follow up.

Exclusion criteria

• Intra articular fractures
• Suspected Pathological fracture.
• Intra-articular Comminution/ compound fracture(G.A- grade 2 or more) / segmental fracture.
• Patient who did not complete follow up.
• Patient who does not have complete radiographic documentation

Table No. 1: AGE DISTRIBUTION

In present study majority of the patients were in the age group of 31-40 years (n=21) followed by 41-50 years (n=12). On comparing age distribution with the Volar Locking plate and Closed reduction and Cast in the extra-articular distal radius fracture we found that out of 30 patients in Group LP, majority were in the age group of 31-40 years (n=10) and 51-60 years (n=6). Similarly out of 30 patients group CC majority were in the age between 31-40 years (n=11) and 41-50 years(n=7). The mean age in Group LP was 42.5 (Range: 26–65) and the mean age in Group CC was 43.36(Range: 26-63). The mean age was comparable in both groups with insignificant p-value of 0.6733.

Table No. 2:

In present study on comparing the distribution of mechanism of injury between groups we found that in Group LP majority of the patients had RTA (60%) as the mechanism of injury whereas 40% had fall. In Group CC, majority of the patients had RTA (53.33%) and 46.67% had fall as the most common mechanism of injury. The distribution of mechanism of injury between the groups was comparable with insignificant p-value of .602.

Table No. 3: PALMAR FLEXION

Palmar Flexion was significantly better in volar locking plate group than Closed reduction and cast group at all follow ups as shown in table with significant p value of <0.001.

Table No. 4: GRIP STRENGTH

Grip Strength in plating group was significantly better in closed reduction and cast group at all follow ups with significant p-value of <0.0001.

Table No. 5: FUNCTIONAL RESULTS BETWEEN GROUPS

At 6 months follow up the final result of functional outcome was compared. Plating group had 10(33.33%) Excellent, 14(46.7%) Good, 06 (20%) Fair and 0 poor functional outcome whereas Closed reduction and cast group had 4(13.33%) Excellent, 8(26.67%) Good, 16(53.33%) Fair and 2(6.67%) Poor outcome, showing that functional outcome of Plating group was better.

In this prospective study conducted in Jayarogya group of hospital comprising of 60 patients with extra-articular fracture distal end radius were randomized in 2 groups (30 each). One group was treated with open reduction and volar locking plate fixation and another was managed conservatively by closed reduction and cast application[11-13].

Fracture of the distal end radius are commonly encountered in orthopaedic practice with increasing number of low energy fractures in the elderely. The importance of anatomic reduction has been suggested by several studies. Accurate reduction of fracture is the first step in treatment .Many options are available to maintain the initial reduction. The most common being closed reduction and cast application, but this is often associated with failure and complications[14].

The study demonstrated better functional and radiological outcome with open reduction and volar plate fixation at 6 months follow up.

In our study the mean age was 43.36 years with range from 26 to 63 years. Maximum patients were in age group 31-40 years. In our study 34 patients (56.67%) had Road Traffic Accident as mode of injury and 26 (43.33%) had Fall on outstretched hand as mode of trauma[15].

In our prospective comparative study with extra articular fracture distal end radius treated with open reduction and volar plate fixation and managed conservatively with closed reduction and cast had a statistically significant (p value <0.05) Green and O‟Brien functional score at 6 months follow-up between the groups, and concluded that open reduction and volar plating has superior and better functional and radiological outcome when compared with Closed reduction and cast application.

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