Retrospective two-center study of volar fixed-angle plate fixation for unstable distal radius fractures in 23 patients aged 75 and older (mean 78.6 years). Follow-up averaged 63 weeks. The central question: can this construct reliably fix osteoporotic bone and permit early mobilization in the elderly?
For decades, unstable distal radius fractures in elderly patients were accepted as a problem without a good surgical answer. Casting fails to hold reduction in osteoporotic bone, K-wires lack purchase, and dorsal plating carries soft tissue morbidity — so suboptimal alignment and prolonged immobilization were often considered acceptable in older patients.
This series established that volar fixed-angle plating changes that calculus. When you have an elderly patient whose closed reduction has failed (more than 15° angulation, more than 2 mm step-off, or more than 2 mm shortening), volar plating with subchondral pegs is a viable operative pathway. Not just for young patients.
The key technical point to carry into the OR: place the subchondral pegs as far distal as possible, flush against the subchondral plate. That contact is what stops settling. Whether you add bone graft is secondary. 63% of these cases healed without any.
The postoperative protocol matters as much as the fixation. Active finger motion starts immediately, the wrist splint comes off at 3 weeks, and patients are back to light ADLs at 2 weeks. Early mobilization is not a risk in this construct, it is the goal.
Retrospective two-center study of volar fixed-angle plate fixation for unstable distal radius fractures in 23 patients aged 75 and older (mean 78.6 years). Follow-up averaged 63 weeks. The central question: can this construct reliably fix osteoporotic bone and permit early mobilization in the elderly?
For decades, unstable distal radius fractures in elderly patients were accepted as a problem without a good surgical answer. Casting fails to hold reduction in osteoporotic bone, K-wires lack purchase, and dorsal plating carries soft tissue morbidity — so suboptimal alignment and prolonged immobilization were often considered acceptable in older patients.
This series established that volar fixed-angle plating changes that calculus. When you have an elderly patient whose closed reduction has failed (more than 15° angulation, more than 2 mm step-off, or more than 2 mm shortening), volar plating with subchondral pegs is a viable operative pathway. Not just for young patients.
The key technical point to carry into the OR: place the subchondral pegs as far distal as possible, flush against the subchondral plate. That contact is what stops settling. Whether you add bone graft is secondary. 63% of these cases healed without any.
The postoperative protocol matters as much as the fixation. Active finger motion starts immediately, the wrist splint comes off at 3 weeks, and patients are back to light ADLs at 2 weeks. Early mobilization is not a risk in this construct, it is the goal.