Preoperative-to-Postoperative Radiological Outcomes Following Open Reduction and Internal Fixation With Volar Locking Plate in Adult Distal Radius Fractures: A Prospective Observational Study.

Background and aim Distal radius fractures (DFRs) are among the most common orthopedic injuries, particularly in elderly and postmenopausal women due to osteoporosis and low-energy trauma, such as falls on an outstretched hand. Restoration of anatomical alignment is essential for optimal functional outcomes, as residual deformity can lead to stiffness, reduced grip strength, malunion, and early degenerative changes. With evolving treatment strategies, open reduction and internal fixation (ORIF) using volar locking plates has become a preferred modality due to its biomechanical stability and facilitation of early mobilization. This study aimed to evaluate postoperative radiological outcomes following volar locking plate fixation and compare them with preoperative parameters. Methods This prospective observational study was conducted over a period of 10 months at a tertiary care center. A total of 50 adult patients with radiographically confirmed closed DFRs were included based on predefined inclusion and exclusion criteria. All patients underwent ORIF using a volar locking plate through a standard volar approach. Preoperative and postoperative radiographs were obtained in AP and lateral views. Radiological parameters assessed included dorsal tilt (expressed postoperatively as loss of palmar tilt), radial inclination, radial height, ulnar variance, and loss of radial deviation. A paired t-test and chi-square test were used for statistical analysis, and outcomes were evaluated using Sarmiento's modification of Lindstrom's criteria. Results The mean age of the study population was 50 ± 13 years, with a predominance of female patients (60%). The most common mechanism of injury was fall on an outstretched hand, observed in 76% of cases. Significant improvement was observed in all radiological parameters following surgical intervention. The mean dorsal tilt improved from 12 ± 4° preoperatively to a postoperative loss of palmar tilt of 0.38 ± 2°. Radial inclination increased from 14.8 ± 2° to 19.8 ± 2°, while radial height improved from 7.98 ± 1 mm to 10.98 ± 1 mm. Ulnar variance decreased from 5 ± 2 mm to 2 ± 2 mm. The mean postoperative loss of radial deviation was 2.8 ± 2°. All observed changes were statistically significant (p < 0.001). Distribution-based analysis demonstrated a marked shift from abnormal preoperative ranges to near-normal postoperative values across all parameters. According to Sarmiento's grading system, 35 (70%) patients achieved excellent outcomes and 15 (30%) achieved good outcomes, with no cases classified as fair or poor. Residual deformity was insignificant in 70% of patients and slight in 30%, with no moderate or severe deformities observed. Conclusions ORIF using a volar locking plate demonstrated favorable immediate postoperative radiological restoration in DFRs and may be considered a reliable option for achieving anatomical alignment. Most patients achieved satisfactory radiological correction with minimal residual deformity in the immediate postoperative period. However, as the present study focused specifically on early radiological outcomes following fixation, further studies incorporating long-term follow-up, functional assessment, fracture union, and complication analysis are required to determine overall clinical effectiveness and long-term outcomes.