Abstract
Complex intraarticular distal radius fractures (DRFs), commonly managed with volar locking plates, are challenging. Combined volar and dorsal plating is frequently applied for treatment, however, biomechanical investigations are scant. The aim of this biomechanical study was to investigate volar plating versus double plating in DRFs with different degrees of lunate facet comminution.Thirty artificial radii with simulated AO/OTA 23-C2.1 and C3.1 DRFs, including dorsal defect and lunate facet comminution, were assigned to 3 groups: Group 1 with two equally-sized lunate facet fragments; Group 2 with small dorsal and large volar fragment; Group 3 with three equally-sized fragments. The specimens underwent volar and double locked plating and non-destructive ramped loading in 0° neutral position, 40° flexion and 40° extension.In each tested position, stiffness: (1) did not significantly differ among groups with same fixation method (p ≥ 0.15); (2) increased significantly after supplemental dorsal plating in Group 2 and Group 3 (p ≤ 0.02).Interfragmentary displacements between styloid process and lunate facet in neutral position were below 0.5 mm, being not significantly different among groups and plating techniques (p ≥ 0.63).Following volar plating, angular displacement of the lunate facet to radius shaft was significantly lower in Group 1 versus both Group 2 and Group 3 (p < 0.01). It decreased significantly after supplemental dorsal plating in Group 2 and Group 3 (p < 0.01), but not in Group 1 (p ≥ 0.13), and did not differ significantly among the three groups after double plating (p ≥ 0.74).Comminution of the lunate facet within its dorsal third significantly affected the biomechanical outcomes related to complex intraarticular DRFs treated with volar and double locked plates.Double plating demonstrates superior stability versus volar plating only for lunate facet comminution within its dorsal third. In contrast, volar plating could achieve stability comparable with double plating when the dorsal third of the lunate facet is not separated by the fracture pattern. Both fixation methods indicated achievable absolute stability between the articular fragments.
Highlights
Volar locking plates have established a standard for reliable fixation across the wide spectrum of distal radius fractures (DRFs) [1]
80% of the intraarticular DRFs can be treated with a single volar plate [2]
A relationship between the stability of those constructs and the degree of lunate facet comminution has not been investigated. We considered it justified to contrast the existing reports – advocating single volar locked plating as being able to provide reliable stability for most dorsally comminuted DRFs – via a carefully designed biomechanical experiment in the current study, in order to provide evidence answering the question which cases would require additional dorsal support [24,25,26,27,28]
Summary
Volar locking plates have established a standard for reliable fixation across the wide spectrum of distal radius fractures (DRFs) [1]. 80% of the intraarticular DRFs can be treated with a single volar plate [2]. A subset of DRFs present a typical comminution pattern of the lunate facet comprising a volar ulnar corner rim fragment, a dorsoulnar fragment, and possibly a free or impacted intraarticular fragment (Fig. 1). This intermediate column fragmentation, observed in both osteoporotic and healthy bone, is recognized as challenging and prone to complication [3,4,5]. The dorsoulnar fragment often comprises part of both the radiolunate and radioulnar articular surfaces and is crucial in maintaining appropriate sagittal radiocarpal alignment and preventing dorsal collapse [7, 8]
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