Association between Radiological and Functional Outcomes Following Volar Locking Plate Fixation of Distal Radius Fractures: A One-Year Prospective Cohort Study

Introduction: Restoring anatomical alignment is a primary objective in the surgical treatment of distal radius fractures. However, the extent to which radiographic restoration influences functional recovery at different stages after surgery remains uncertain. Clarifying this relationship may help guide postoperative assessment and rehabilitation. Aim: To investigate the association between radiological alignment and functional outcomes over one year in adults with distal radius fractures treated with Volar Locking Plate (VLP) fixation. Materials and Methods: This prospective observational cohort study was conducted at the Department of Orthopaedics, Himalayan Institute of Medical Sciences, Jolly Grant, Dehradun, Uttarakhand, India, from November 2024 to May 2025. A total of 55 adults aged 18-60 years with distal radius fractures were managed by open reduction and internal fixation using a VLP. Radiological outcomes were assessed using the Sarmiento radiological scoring system, while functional recovery was evaluated with the Modified Mayo Wrist Score (MMWS). Patients were assessed immediately after surgery and subsequently at six weeks, three months, six months, and 12 months. Changes in functional outcomes over time were analysed, and the association between radiological and functional outcomes was examined using the Chi-square test. Results: The mean age of the subjects was 44.75±12.45 years, comprising 29 males and 26 females. The majority of fractures were complex intra-articular injuries, with Frykman Type VII accounting for 34.5% (n=19) and Type VIII accounting for 21.8% (n=12) of the study population. Functional recovery progressed steadily, with the mean MMWS increasing from 68.27 at six weeks to 84.50 at one year. No significant association was observed between radiological alignment and functional outcome at six weeks (p=0.107). However, a significant positive association emerged at three months (p=0.005) and persisted through the six-month and one-year follow-up assessments. Conclusion: The relationship between radiological alignment and functional recovery is time-dependent and appears to evolve during fracture healing.