Role of aspanning plate as an internal fixator in complex distal radius fractures.

Abstract

Minimally invasive temporary internal wrist arthrodesis as an alternative treatment method in complex distal radius fractures. Complex distal radius fractures with dorsal and/or palmar comminution and little to no reconstruction possibilities, radiocarpal ligamentous injury, need for early weight bearing through the affected wrist (walking aids). Complex hand injuries limiting the possibility to safely secure the plate at either the metacarpal or the radial shaft. Percutaneous or open reduction and fixation of the distal radius fracture. Determine the location for the two stab incisions under fluoroscopy; one over the distal radial diaphysis and one over the second or third metacarpal. Athird incision over Lister's tubercle allows transposition of the extensor pollicis longus (EPL) tendon, excision of the posterior interosseous nerve and dorsal arthrotomy. Retrograde insertion of the spanning plate. Placement of afirst nonlocking screw through the glide hole into the metacarpal shaft. Under traction, aproximal screw hole is filled with anonlocking screw into the radial diaphysis. Tightening of the cortical screws under lateral fluoroscopic view. The remaining screw holes at both the distal and proximal ends of the plate are filled with locking screws. Layered wound closure. A removable wrist splint is worn during 2weeks. Weight bearing through the injured wrist is immediately allowed. Removal of the spanning plate is scheduled at 3months after radiographic evidence of fracture consolidation. In total, twelve distal radius fractures were treated by dorsal spanning plate fixation between January 2018 and January 2019. Average age was 53.3 ± 24.5years (range 22-95years). Both 3.5 mm and 2.4/2.7 mm plates were used. All twelve fractures were healed after 3months. The mean Disabilities of Arm, Shoulder and Hand (DASH) score was 36.4 (range 8.3-70.0). There was one EPL tendon rupture, one case with extensor tendon adhesions, one periosteosynthetic fracture of the radial shaft and one complex regional pain syndrome. There was no implant failure and no infection.