Palmar and dorsal fixed-angle plates in AO C-type fractures of the distal radius: is there an advantage of palmar plates in the long term?

Michael G Jakubietz,Rafael G Jakubietz,Joerg G Gruenert

doi:10.1186/1749-799x-7-8

Michael G Jakubietz, Rafael G Jakubietz + Show 1 more

Open Access

https://doi.org/10.1186/1749-799x-7-8

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Abstract

BackgroundCurrent surgical approaches to the distal radius include dorsal and palmar plate fixation. While palmar plates have gained widespread popularity, few reports have provided data on long term clinical outcomes in comparison. This paper reports the result of a randomised clinical study comparing dorsal Pi plates and palmar, angle-stable plates for treatment of comminuted, intraarticular fractures of the distal radius over the course of twelve months.Methods42 patients with unilateral, intraarticular fractures of the distal radius were included and randomised to 2 groups, 22 were treated with a palmar plate, 20 received a dorsal Pi-plate. Results were evaluated after 6 weeks, 3, 6 and 12 months postoperatively focussing on functional recovery as well as radiological results.ResultsThe palmar plate group demonstrated significantly better results regarding range of motion and grip strength over the course of 12 months. While a comparable increase in function was observed in both groups, the better results from the early postoperative period in the palmar plate group prevailed over the whole course. Radiological results showed a significantly increased palmar tilt and carpal sag in dorsal plates, with other radiological parameters being comparable. Pain levels were decreased in dorsal plates after hardware removal and failed to show significant differences after 12 months. However, complications such as tendon ruptures were more frequent in the dorsal plate group.ConclusionsFunctional advantage of palmar plates gained within the first 6 weeks prevails over the course of a year. Both groups demonstrate further gradual increase of function after 6 months, although dorsal plates did not catch up completely. Improved early postoperative function seems to be the cornerstone for the best possible results. Patients with dorsal plates benefit from hardware removal more than palmar plates in terms of reduction of pain levels. The advantage of palmar plates is a faster functional recovery with lower complication rates. This is especially important in the elderly population. Radiological results did not show a superiority of palmar plates over dorsal plates.

Highlights

Fractures of the distal radius are the most common fractures in the upper extremity and treatment options have been controversially discussed throughout the literature over the last decades [1,2,3,4,5]
In an attempt to determine whether the short term advantage of palmar plates prevails in the long term, a larger group of patients was evaluated as a continuation of our previous study [5]
50 patients, operated on in a period of 8 months were initially registered in the study and 42 patients with unilateral AO-type C1, C2 and C3 fractures of the distal radius were included as they completed the complete follow up including hardware removal after 6 months

Summary

Introduction

Fractures of the distal radius are the most common fractures in the upper extremity and treatment options have been controversially discussed throughout the literature over the last decades [1,2,3,4,5]. In an attempt to determine whether the short term advantage of palmar plates prevails in the long term, a larger group of patients was evaluated as a continuation of our previous study [5]. The main objective was to evaluate if radiological and functional results displayed a statistical significance and to possibly prove further advantages of palmar plating systems in the longer term, and to evaluate potential benefits of hardware removal in regard to function, pain, and patient satisfaction. Current surgical approaches to the distal radius include dorsal and palmar plate fixation. This paper reports the result of a randomised clinical study comparing dorsal Pi plates and palmar, angle-stable plates for treatment of comminuted, intraarticular fractures of the distal radius over the course of twelve months

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