Dorsal locked plate fixation in dorsally unstable distal radius fractures

Abstract

Introduction: Distal radius fractures are common, and internal fixation for operative management of these injuries is widely accepted. Although use of the volar approach for plate fixation has become more popular, benefits of the dorsal surgical approach include the potential for direct reduction and assessment of articular alignment, evaluation and management of concomitant intrinsic intercarpal ligament injury, and initiation of early range of motion. For certain fracture patterns, dorsal plate fixation is the preferred surgical technique. Improvements in implant design, in particular the use of low-profile dorsal plates, has decreased the rate of complications seen previously with this technique. Purpose of the study: We are trying into evaluate the functional outcome of distal radius fractures treated by open reduction internal fixation [ORIF] with precontoured low profile dorsal locking plates. Material and Methods: We performed ORIF with dorsal plating in 40 patients (16 males and 24 females) for distal radius fractures according to our inclusion and exclusion criteria. Fractures were classified by AO classification. Patients were followed up at routine intervals and the functional outcome was evaluated by the Disabilities of the Arm, Shoulder, and Hand questionnaire, the Gartland and Werley scoring system and modified Green O’ Brien score. All plates were low profile and stainless steel. Radiographic parameters, range of motion, and strength compared with the uninjured side were recorded. Results: According to the AO classification system, there were 5 type A fractures, 6 type B fractures, and 29 type C fractures. The median preoperative dorsal angulation was 30°, and the median postoperative angulation was -4° volar. Twenty-six patients with fractures had an intra-articular step-off or gap, which were all corrected to neutral by the procedure. Seven patients with the fractures showed positive ulnar variance, all corrected to neutral at time of follow-up evaluation. The median patient age at surgery was 59 years. The median follow-up period was 18 months Compared with the contralateral side, the mean extension and flexion were 88% and 81%, respectively; pronation and supination were 89% and 87%, respectively; and grip strength and thumb pinch were 78% and 94%, respectively. The mean postoperative Disabilities of the Arm, Shoulder, and Hand questionnaire score was 15 points. 38 patients had Gartland and Werley scores of good or excellent. No patients needed to have their plates removed, and no extensor tendon rupture was reported. 1 patient lost reduction; 1 patient needed a tenolysis of the extensor pollicis longus tendon. Out of 40 patients, 31 patients had excellent results, 7 patients had good results and 1 had fair and only 1 patient had poor result, according to the modified Green O’ Brien score. Average time to clinico-radiological union was 7 weeks. Average follow up time was 18 months. Conclusion: Our study has demonstrated that dorsal plating is an effective method for management of dorsally unstable distal radius fractures.