Unstable Distal Radial Fracture Management with Locking Plates and Injectable Bone Graft – The Geelong Experience RS. Page, AJR Oppy Barwon Orthopaedic Research Unit, Geelong Hospital, Victoria, Australia. Summary Internal fixation of distal radial fractures using the volar locking plate systems is becoming increasingly popular with little support from the orthopaedic literature 1 . This study aimed to assess the clinical and radiological outcome of 45 radial fractures with an average age of 52 years where distal radial volar locking plate (DRVLP, Synthes) systems were used to treat complex intraarticular distal radial fractures. We report excellent post-operative radiographical results along with excellent clinical outcomes as measured by the validated patient rated wrist evaluation score (PRWE) supporting the continued use of these systems. Introduction With an increasing elderly population, the most common fracture the orthopaedist cares for is that of the distal radius. Many techniques for managing these fractures have been described, including: manipulation and plaster, percutaneous or intramedullary wires, external fixation, and internal fixation with simple implants to specifically anatomically designed implants. Locking plates have revolutionised the treatment of osteoporotic fractures 2 , and these implants have now been specifically designed and contoured to form the Distal Radial Volar Locking Plate (DRVLP), now produced by multiple companies. Although these implants are being increasingly used by surgeons, the radiological and clinical outcome data is scarce. It was our aim to fill this void by performing a radiological and clinical review of all DRVLPs inserted at a single hospital by all surgeons within the unit. The clinical review was performed in the form of a validated patient rated wrist evaluation (PRWE) 3 . Supplemental bone void filler graft was utilised in 15 cases and was also reviewed as part of our study. Materials and Methods Utilising multiple hospital audit database systems, patients who had sustained distal radial fractures treated with any brand of DRVLP were identified. Selection criteria for the use of the DRVLP was surgeon selection on each individual case as judged by comminution and intra-articular involvement. Only volar locking plates were included. Bone void filler graft was used if so desired by the surgeon. All cases that utilised graft used the injectable calcium sulphate traded as MIIG X3 (Wright Medical Group Inc). Post operative rehab was not specified and was also surgeon and case dependant. This study was approved by our hospital ethics committee and data recorded from patient’s histories included: demographics, surgeon, side, prosthesis used and the use of bone void filler graft. Outcome evaluations were performed via standard anteroposterior and lateral projection radiographs at 6 weeks, and then 3 monthly.