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Arch Hand Microsurg > Volume 20(3); 2015 > Article
Original Article
Journal of the Korean Society for Surgery of the Hand 2015;20(3):96-103.
Published online September 30, 2015.
DOI: https://doi.org/10.12790/jkssh.2015.20.3.96   
Volar Locking Plate Fixation for Distal Radius Fractures in Hemodialysis Patients
Jin Hyung Im, Sung Woo Huh, Min Kyu Park, Joo Yup Lee
1Department of Orthopedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea. jylos@gmail.com
2Department of Orthopedic Surgery, Hong-Ik Hospital, Seoul, Korea.
Received: 26 July 2015   • Revised: 1 September 2015   • Accepted: 3 September 2015
Abstract
Purpose
Although the possibility of distal radius fractures is strong in hemodialysis patients, there are many difficult problems such as the bleeding tendency, hypervascularity and injury to arteriovenous fistula. We studied the outcomes of open reduction and volar locking plate fixation of the distal radius fractures in hemodyalisis patients with ipsilateral arteriovenous fistula.

Methods
From 2007 to 2009, a retrospective chart review was performed of eleven hemodialysis patients who underwent volar locking plate fixation for treatment of distal radius fractures. Eight of them were female and three were male and mean age was 68 years (range, 57-81 years). Mean follow-up period was 19 months (range, 12-28 months). All patients had osteoporosis with mean T-score of -2.7. All operations were performed on the next day of hemodialysis. Scheduled hemodialysis was possible on the next day of surgery without splint. We analyzed radiographic results, the wrist range of motion, Mayo wrist score and disabilities of the arm, shoulder and hand (DASH) score at the last follow-up.

Results
All fractures achieved anatomical reduction and united at final follow-up. Complications such as hematoma or occlusion of arteriovenous fistula were not observed. Mean Mayo wrist score was 78 and mean DASH score was 22.

Conclusion
Volar locking plate fixation for distal radius fractures provides immediate support for continuing hemodialysis and exercise. Open reduction of the fractures and the use of tourniquet don't seem to increase the vascular complications like hematoma and fistula occlusion.
 
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