When to Choose a Variable Volar Locking Plate for Distal Radius Fractures?
Distal radius fractures are some of the most common fractures orthopedic surgeons treat, and fixing them right matters, especially for active adults who want to get back to full function fast. In last few years, variable volar locking plates have become an ideal solution. But when does it make sense to choose a variable angle volar locking plate instead of a standard fixed-angle one? Let’s break it down from a practical, surgeon-centered point of view.
The Appeal of Variable Angle Locking Plates
A variable volar locking plate offers a distinct advantage: it lets you customize screw placement within a range, typically around 15 degrees in multiple directions. That means you aren’t locked into one trajectory. This flexibility is gold when dealing with complex fracture patterns, comminution, or unique bone morphology.
In the OR, fractures rarely read the textbook. Dorsal comminution, intra-articular extension, and small displaced fragments can make achieving stable fixation tricky. A variable angle plate gives you options of angling screws to best support subchondral bone, dodge fracture lines, or capture small fragments without over-drilling or stripping out.
When It Matters Most?
Intra-articular fractures
When the break crosses into the joint surface, anatomical reduction is critical. You’re not just trying to heal a bone; you’re preserving wrist function. Variable angle screws allow you to aim directly at specific fragments that need buttressing or compression, especially helpful in AO Type C fractures. This can mean fewer fragments left unsupported and less risk of post-traumatic arthritis down the line.
Osteoporotic bone
Older patients present a double challenge: often more comminuted fractures and poorer bone quality. Fixed-angle plates can sometimes miss the mark. The ability to choose the best screw angle can help engage denser bone regions, improve purchase, and reduce the risk of hardware failure. You’re also less likely to cause joint penetration, a real risk when you’re forced to use a single screw angle on thin cortical bone.
Fragment-specific control
In fractures with radial styloid involvement, volar lunate facet displacement, or dorsal split fragments, the standard screw trajectory may not provide adequate support. Being able to adjust screw direction lets you create a more “fragment-specific” construct without needing multiple incisions or additional hardware. You can essentially tailor your fixation to the fracture rather than adapting the fracture to the implant.
Revising suboptimal reductions
In some cases, particularly in delayed presentations or poorly reduced fractures, getting back to ideal alignment requires improvisation. A variable angle system can help adjust the construct as you refine the reduction, instead of forcing you to compromise fixation to match the plate.
Cautions and Considerations
Variable angle doesn’t mean a free-for-all. It still demands precision. Over-angulation can weaken screw-plate interface strength, and inconsistent trajectories can compromise the overall construct stability. You also need to be mindful of the learning curve; surgeons must be comfortable visualizing trajectories and confirming placement with fluoroscopy or intraoperative imaging.
Additionally, not every fracture needs this level of adaptability. For clean, extra-articular breaks with solid bone quality, a fixed-angle plate often works just fine and can be more straightforward to apply.
Final Thoughts
Variable volar locking plates aren’t the only solution, but they are a powerful tool when used correctly. Their ability to adapt to fracture complexity, bone quality, and patient anatomy can mean more stable fixation, fewer complications, and better functional outcomes. Like most trauma implants in orthopedics, it’s all about knowing when and how to use them.
