Complex Distal Radius Fractures Research Articles

Systematic review: dorsal bridge plating in distal radius fractures.

Distal radius fractures are the most common upper limb fractures in adults (up to 18% of all fractures in the Emergency Department). Conservative management is possible for the majority, the preferred surgical technique being volar plate fixation. Dorsal bridge plating (DBP) is an alternative method of treatment for complex fractures. DBP acts as an internal fixator and can be used in patients needing early rehabilitation. This systematic review assesses the demographics, functional and radiological outcomes and complications of using DBP in patients with distal radius fractures compared to volar plate fixation. A literature search of PubMed, Cochrane, EMBASE and Google Scholar was performed according to PRISMA guidelines. Seven hundred and sixty-one articles were found; 11 articles met the inclusion criteria. Cadaveric studies and case studies of less than five patients were excluded. Primary outcome measures were functional and radiological outcomes. Complications were recorded as secondary outcomes. Three hundred and ninety-four patients were included in the study with an average age of 54.8 years (53.9% male and 46.1% female). Weighted mean follow-up was 55.2 weeks; the mean time to plate removal was 17.3 weeks with a mean DASH score of 25.7. The weighted range of movement was 46.9° flexion, 48.8° extension, 68.4° pronation and 67.5° supination. The radiological parameters show satisfactory outcomes with a mean radial height of 10mm, volar tilt of 3.1°, ulnar variance of 0.5mm and radial inclination of 18.8°. The complication rate was 11.4%. Digital stiffness was the most common complication but improved if tenolysis was performed at plate removal. DBP is a good alternative to volar plating for complex distal radius fractures. The functional outcomes showed a slight loss of range of movement, whereas the radiological outcomes were within recommended limits. A significant disadvantage of the plate is the need for further surgical removal.

Systematic review: dorsal bridge plating in distal radius fractures.

Distal radius fractures are the most common upper limb fractures in adults (up to 18% of all fractures in the Emergency Department). Conservative management is possible for the majority, the preferred surgical technique being volar plate fixation. Dorsal bridge plating (DBP) is an alternative method of treatment for complex fractures. DBP acts as an internal fixator and can be used in patients needing early rehabilitation. This systematic review assesses the demographics, functional and radiological outcomes and complications of using DBP in patients with distal radius fractures compared to volar plate fixation. A literature search of PubMed, Cochrane, EMBASE and Google Scholar was performed according to PRISMA guidelines. Seven hundred and sixty-one articles were found; 11 articles met the inclusion criteria. Cadaveric studies and case studies of less than five patients were excluded. Primary outcome measures were functional and radiological outcomes. Complications were recorded as secondary outcomes. Three hundred and ninety-four patients were included in the study with an average age of 54.8 years (53.9% male and 46.1% female). Weighted mean follow-up was 55.2 weeks; the mean time to plate removal was 17.3 weeks with a mean DASH score of 25.7. The weighted range of movement was 46.9° flexion, 48.8° extension, 68.4° pronation and 67.5° supination. The radiological parameters show satisfactory outcomes with a mean radial height of 10mm, volar tilt of 3.1°, ulnar variance of 0.5mm and radial inclination of 18.8°. The complication rate was 11.4%. Digital stiffness was the most common complication but improved if tenolysis was performed at plate removal. DBP is a good alternative to volar plating for complex distal radius fractures. The functional outcomes showed a slight loss of range of movement, whereas the radiological outcomes were within recommended limits. A significant disadvantage of the plate is the need for further surgical removal.

Gaining control over complex distal radius and ulna fractures: tips and tricks.

Gaining control over complex distal radius and ulna fractures: tips and tricks.

The usefulness of bioabsorbable magnesium implants in addition to metal plates in the treatment of complex distal radius fractures

Purpose: The aim of this study was to determine whether normal plating yields comparable outcomes to plating using additional bioabsorbable screws or wires for complex distal radial fractures.Methods: Among 80 patients with complex distal radius fractures treated between January 2018 and March 2021, 45 were studied retrospectively and divided into two groups as follows: group A (n=23) received a plate, and group B (n=22) received a plate with a bioresorbable screw or wire. Radiological studies evaluated the period of bone union, radial length, inclination, and resorption of the bioresorbable screws or wires after surgery. The Disabilities of the Arm, Shoulder, and Hand (DASH) score was examined for clinical evaluation, and complications were compared between the two groups.Results: The two groups showed similar distributions in sex, age, injury mechanism, diabetes mellitus, smoking, and mean follow-up period; however, there were no statistically significant differences in the period of bone union and maintenance of reduction (radial length, inclination, and volar tilt). The DASH score averaged 14.8 and 13.2 points in groups A and B, respectively, showing no significant difference in complications (nonunion, malunion, infection, and arthritis).Conclusion: Regardless of the use of additional bioresorbable screws or wires, reduction in distal radius fractures in both groups yielded good results. Plating with additional bioresorbable screws or wires may be a suitable fixation method to compensate for the shortcomings of metal implants in complex distal radius fractures.

Bridge Plate Distraction for Complex Distal Radius Fractures: A Cohort Study and Systematic Review of the Literature.

Background Dorsal bridge plating (DP) of the distal radius is used as a definitive method of stabilization in complex fracture configurations and polytrauma patients. Questions/Purposes This review aims to summarize the current understanding of DP and evaluate surgical outcomes. Methods Four databases were searched following the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines and registered with PROSPERO. Papers presenting outcome or complication data for DP were included. These were reviewed using the National Institutes of Health Quality Assessment and Methodological Index for Non-Randomised Studies tools. Results were collated and compared to a local cohort of DP patients. Results Literature review identified 416 patients with a pooled complication rate of 17% requiring additional intervention. The most prevalent complications were infection/wound healing issues, arthrosis, and hardware failure. Average range of motion was flexion 46.5 degrees, extension 50.7 degrees, ulnar deviation 21.4 degrees, radial deviation 17.3 degrees, pronation 75.8 degrees, and supination 72.9 degrees. On average, DP removal occurred at 3.8 months. Quality assessment showed varied results. There were 19 cases in our local cohort. Ten displayed similar results to the systematic review in terms of range of motion and radiographic parameters. Higher QuickDASH scores and complication rates were noted. Local DP showed earlier plate removal at 2.9 months compared to previous studies. Conclusion DP is a valid and useful technique for treating complex distal radius fractures. It displays a lower risk of infection and pain compared to external fixation which is commonly used to treat similar injuries. Patients can recover well following treatment both in function and range of motion. Further high-quality studies are required to fully evaluate the technique.

Distal Radius Fracture Outcomes After Dorsal Spanning Plate Fixation

Dorsal spanning plate fixation can be used to treat comminuted distal radius fractures not amenable to volar plating. However, there is a relative paucity of outcomes data; so, the aim of this retrospective study was to investigate outcomes and complications after dorsal spanning plate fixation for distal radius fractures. Distal radius fractures treated with dorsal spanning plate fixation at a level-1 trauma center were retrospectively identified via Current Procedural Terminology coding and chart review from 2014 to 2019. Patient demographics, fracture pattern characteristics, fixation techniques, and clinical outcomes were all obtained via chart review using the electronic medical record. In all, 43 dorsal plates were identified out of 369 operatively treated distal radius fractures (12%). Of these, 84% were AO type C, 28% were open fractures, and 86% resulted from falls. At the time of dorsal plating, 28% had an additional procedure. One patient had a major complication after surgery, requiring unplanned surgery for a radius nonunion. Average final follow-up occurred 9 weeks after dorsal plate removal, with mean range of motion at the wrist measuring: 36° flexion, 48° extension, 75° pronation, and 63° supination. Finger flexion was also measured, using either tip of finger to palm distance or total active motion, depending on the available data. These were measured at an average of 1.2 cm and 194°, respectively. Dorsal spanning plate fixation provides a safe and effective method for treating complex distal radius fractures. In our series, patients had good functional outcomes with few complications.

Bridge plating in the setting of radiocarpal instability: Does distal fixation to the second or third metacarpal matter? A cadaveric study.

Radiocarpal dislocations are rare but potentially devastating injuries. Poorer outcomes are associated with inadequate or lost reduction, such as ulnar translocation, but no consensus exists on the ideal fixation technique. Dorsal bridge plate fixation has been described for various settings in the treatment of complex distal radius fractures and can be fixed distally to the second or third metacarpal, but its application for radiocarpal dislocations has not been established. To determine whether distal fixation to the second or third metacarpal matters. Using a cadaveric radiocarpal dislocation model, the effect of distal fixation was studied in two stages: (1) A pilot study that investigated the effect of distal fixation alone; and (2) a more refined study that investigated the effect of described techniques for distal and proximal fixation. Radiographs were measured in various parameters to determine the quality of the reduction achieved. The pilot study found that focusing on distal fixation alone without changing proximal fixation results in ulnar translocation and volar subluxation when fixing distally to the second metacarpal compared with the third. The second iteration demonstrated that anatomic alignment in coronal and sagittal planes could be achieved with each technique. In a cadaveric radiocarpal dislocation model, anatomic alignment can be maintained with bridge plate fixation to the second metacarpal or the third metacarpal if the described technique is followed. When considering dorsal bridge plate fixation for radiocarpal dislocations, the surgeon is encouraged to understand the nuances of different fixation techniques and how implant design features may influence proximal placement.

The Use of Montage Bone Putty in Assisting in the Maintenance of Reduction in Comminuted Distal Radius Fractures.

Background The distal radius fracture is the most common fracture in the United States. Achieving stable reduction and fixation of complex fracture patterns can be challenging. In order to help maintain reduction of comminuted fracture to simplify plating, the calcium phosphate-based bone putty Montage has been developed. Questions/Purposes Does Montage assist in achieving stable reduction and fixation of complex distal radius fractures with an acceptable complication profile? Patient and Methods We retrospectively analyzed all patients who were treated intraoperatively with Montage bone putty along with volar plate fixation at a large-volume urban county hospital. Preoperative, intraoperative, and postoperative measurements of radiographic features were recorded at 2 and 6 months, as were any complications. Statistical analysis was then performed on these values. Results Preoperative and postoperative radiographs demonstrated significant improvement in standard distal radius fracture measurements, reflecting adequate reduction with the use of Montage intraoperatively. Critically, radiographs demonstrated maintenance of reduction compared to intraoperative fluoroscopy images at 2 months, showing short-term stability of the use of Montage in these fracture patterns as well as long-term stability at 6 months in a subset of patients. There were no major complications in this study. Conclusion In this study, we demonstrate the utility of Montage bone putty for complex distal radius fractures with short-term follow-up and limited long-term follow-up. This initial study underlines its efficacy in maintaining reduction without major complications. Level of Evidence IV, Therapeutic.

A clinical study to determine the functional outcome of distal end radius fracture managed with volar locking plate and screws

Background and Objective: Fracture of the distal radius is one of the most common skeletal injuries treated by orthopaedic surgeons. For a favourable functional outcome, radial length, radial tilt angle, and articular surface congruity must all be restored. Recognition of fracture patterns and fixation of fracture to maintain reduction is the key for successful management of complex fractures of distal radius. Volar locking plates allow improved fracture fixation without leading to soft tissue and vascular complications. They have been shown to provide excellent stability for an unstable fracture with volar Metaphyseal comminution. The objective of the study was to evaluate the clinical and functional outcome of fracture of distal end of radius treated by ORIF by Volar locking plate and screws using Criteria of Gartland and Werley Point System. Methods: Thirty patients with fracture of distal end radius were treated by ORIF by Volar locking plate and screws in Karnataka institute of medical sciences, hubballi. Between from November 2020 to September 2022. Results: The study included 30 patients, 27 male and 3 females aged from 21 to 69 years with mean of 33.53 years. The average duration of follow-up was 12 months. Using the Demerit scoring system of Gartland and Werley score, we had 20% excellent results, 50% good results, 16.67% fair results and 13.3% poor result. As per our results, excellent to good results were found in 70% of patients. Interpretation & Conclusion: ORIF by Volar locking plate and screws can be an alternative to other procedures in treating the extra-articular fracture with volar displacement and volar Barton’s fracture radius. Excellent to good results are produced by using volar locking plate for fixation of distal radius fractures.

Complex distal radius fracture (CDRF) with median nerve injury management using one-stage distraction bridge plate fixation (DBPF) without nerve exploration allows nerve function recovery: a case report

Background: Complex distal radius fracture (CDRF) associated with median nerve injury is rarely reported due to low incidence or low recognition rate. Thus, we reported the outcome of using distraction bridge plate fixation (DBPF) in managing CDRF associated with median nerve injury without volar nerve exploration. Case description: We reported a 67-years old male who sustained pain in the right wrist with dorsal angulated deformation following a fall on an outstretched hand two hours before being admitted to the emergency department. The patient also complained of numbness in all of the fingers except the little finger of the right hand. Posteroanterior (PA)/right lateral X-rays showed grossly dorsal displaced of the comminuted distal radius fracture associated with ulnar styloid avulsion. The diagnosis was a CDRF associated with median nerve injury. He underwent surgery in an emergency setting with DBPF on the dorsal side without opening the fracture site guided by an image intensifier. Early mobilization was started as the patient could tolerate the pain, and neuromuscular electrical stimulation was given twice a week after surgery. Plate removal was done six months after surgery and continued with a range of motion exercise of the right wrist. Conclusion: It is important to consider the anatomical reduction without additional soft tissue trauma by opening the fracture site and the early emergency surgery decision based on physical examination in CDRF management. The stable fixation allows axonal regeneration after median nerve injury, proved by good nerve functional outcomes. DBPF is suitable for post-operative wound care and decreases costs compared to staged fixation surgery and volar nerve exploration. However, we still need to further investigate this procedure through higher comparison studies.

Wrist & Hand

The December 2022 Wrist & Hand Roundup360 looks at: Anti-tumour necrosis factor therapy for early-stage Dupuytren’s disease; Patient experiences of scaphoid waist fractures and their treatment; Postoperative complications following open a1 pulley release for a trigger finger or thumb; How certain are findings in distal radius fractures: a systematic review of randomized controlled trials; Partial wrist denervation in wrist osteoarthritis: patient-reported outcomes and objective function; Dorsal bridge plating versus bridging external fixation for management of complex distal radius fractures; How is reduction lost in distal radius fractures in females aged 50 years and older; The HAND-Q: psychometrics of a new patient-reported outcome measure for clinical and research applications.

The Association of Low Skeletal Muscle Mass with Complex Distal Radius Fracture.

Objectives: Sarcopenia is a skeletal muscle loss disease with adverse outcomes, including falls, mortality, and cardiovascular disease (CVD) in older patients. Distal radius fractures (DRF), common in older people, are strongly related to falls. We aimed to investigate the correlation between DRF and low skeletal muscle mass, which strongly correlated to sarcopenia. Methods: We performed a retrospective review of data from patients diagnosed with or without DRF in our institute between 2015 and 2020. Finally, after propensity score matching, data from 115 patients with and 115 patients without DRF were used for analyses. Multivariate logistic regression analysis was performed for sex, body mass index (BMI), the presence of low skeletal muscle mass, bone quality measured by dual-energy X-ray absorptiometry (DXA), and comorbidities (diabetes mellitus, CVD). Results: We found that female sex (odds ratio = 3.435, p = 0.015), CVD (odds ratio = 5.431, p < 0.001) and low skeletal muscle mass (odds ratio = 8.062, p = 0.001) were significant predictors for DRF. BMI and osteoporosis were not statistically significantly related to DRF. Conclusions: Women with low skeletal muscle mass and CVD may be more responsible for DRF than osteoporosis.

Dorsal bridge plating versus bridging external fixation for management of complex distal radius fractures

IntroductionDistal radius fractures are the most frequent upper limb injuries encountered by orthopedic surgeons. Surgical treatment of distal radius fractures is preserved for unstable and displaced fractures. A randomized controlled trial was conducted to compare the radiological and functional outcomes of bridge plating (BP) to external fixation (EF) in comminuted intra-articular distal radius fractures. MethodsSixty patients with distal radius fractures were eligible for treatment by means of ligamentotaxis using either a dorsal bridge plate (30 patients) or an external fixator (30 patients) with or without supplementary Kirschner wires (K-wires). Radiological evaluation was done using the radial inclination angle, radial length, and the volar tilt. Clinical evaluation was performed using ranges of wrist motion, grip strength, Visual Analogue Scale (VAS), and a validated Arabic version of the Disability of the Arm, Shoulder, and Hand (DASH) questionnaire ResultsPatients were followed up for 12 months. No significant difference was found in terms of radiographic parameters or ranges of wrist motion. At 3-months follow-up, bridge plating group had stronger grip strength, lower Disability of the Arm, Shoulder, and Hand scores, and lower Visual Analogue Scale. However, both groups had similar functional outcomes at last follow-up. External fixation group had a higher rate of postoperative complications. ConclusionIn comparison to external fixation, bridge plating may provide earlier functional recovery with lower complication rates. However, no functional or radiological superiority were demonstrated at 12-months follow-up.

Radiological, Clinical, and Functional Outcomes of Combined Dorsal and Volar Locking Plate Osteosynthesis for Complex Distal Radius Fractures

The purpose of this study was to assess the short- to mid-term radiologic, clinical, and functional outcomes of patients treated with combined dorsal and volar locking plating for internal fixation of complex, comminuted, intra-articular, distal radius fractures. We performed a retrospective review of 34 patients treated with combined dorsal and volar locking plates for the internal fixation of complex, comminuted, intra-articular distal radius fractures. Radiographic and clinical parameters were recorded at a mean of 48 months after surgery. Activities of daily living and quality of life were assessed by the Disabilities of the Arm, Shoulder, and Hand and Patient-Rated Wrist Evaluation questionnaires. Compared with the contralateral wrist, the treated wrist regained 73% of flexion, 81% of extension, 86% of ulnar deviation, 90% of radial deviation, 98% of pronation, 99% of supination, and 93% of grip strength. Mean Disabilities of the Arm, Shoulder, and Hand and Patient-Rated Wrist Evaluation scores were 11 (range, 0-78) and 11 (range, 0-77), respectively. Radial height and radial inclination were restored anatomically in 24% and 41% of patients, respectively, while volar tilt and ulnar variance were restored in 68% of patients. The overall functional and radiologic outcome of patients with comminuted intra-articular complex distal radius fractures treated with the combined dorsovolar plate osteosynthesis was good to excellent. Therapeutic IV.

The use of phalangeal plate as "hook plate" and external fixation to treat complex distal radius fracture fragments.

The use of phalangeal plate as "hook plate" and external fixation to treat complex distal radius fracture fragments.

Dorsal Plate Osteosynthesis in Simple and Complex Fractures of the Distal Radius: A Radiological Analysis of 166 Cases.

Background To report the radiologic outcome and rate of complications of open reduction and internal fixation (ORIF) using a dorsal plate fixation of simple and complex distal radius fractures in adult patients. Methods Patients treated with dorsal ORIF of simple and complex distal radius fractures between December 2008 and April 2013 were included in this single-center retrospective study. Type of fracture, radiographic measurements, and complications were documented. Results One-hundred and sixty-six patients/fractures were included. Restoration of radial inclination (22° ± 3°) was achieved in 38%. Radial height (14 ± 1 mm) was least likely to be restored to normal values postoperative in 25%. Normal ulnar variance (0.7 ± 1.5 mm) could be observed in 60% and adequate volar tilt (11° ± 5°) was achieved in 50% at final follow-up. We observed one loss of reduction in an AO type C2 fracture and a total of 15 nonimplant-related minor clinical complications. Conclusion Our radiographic findings after dorsal plating are comparable to those published on volar plating. The changes in radial height and volar tilt could be attributed to projection-related differences in the radiographs and did not signify a loss of reduction in all cases. Clinical Relevance Dorsal plating of distal radius fractures is safe and remains an important approach in the treatment of complex distal radius fractures. Complications in our study were even less compared to those reported in the literature. Type of Study/Level of Evidence This is a Type IV study. Level of Experience of Surgeons The level of experience of surgeons is III–V.

Distal Radius Fractures: Recognizing and Treating Complex Fracture Patterns.

Volar fixed-angle plate fixation is a commonly used treatment modality for distal radius fractures. However, not all fracture patterns are amenable to this type of fixation strategy. In this article, we review pertinent anatomy and radiographic landmarks that together highlight key differences when considering treatment strategies for complex distal radius fractures.

Lessons learned with the Cobra prosthesis in elderly patients with complex distal radius fractures\u2014a retrospective follow-up study

IntroductionRecently, the Cobra prostheses were introduced in the treatment of distal radius fractures (DRF) of elderly patients. Fracture prostheses provide an alternative treatment option for complex fractures where conservative therapy seems not acceptable and osteosynthesis seems not possible. Data reporting the feasibility of the Cobra prosthesis are sparse. Therefore, this retrospective follow-up study investigated the clinical and radiological mid-term outcome of the Cobra implant in complex DRFs of elderly patients.Materials and methodsThirteen patients (mean age 73.5 years, range 65–87 years) were retrospectively evaluated with at least a 1-year follow-up after surgery. Objective and subjective clinical parameters as well as the radiological outcome and complications were analyzed.ResultsThe mean follow-up period was 31.2 months. Seven cases required a cemented prosthesis. The mean relative range-of-motion compared to the healthy side was 72.3% and 51.8% for extension and flexion, respectively, and 87.9% and 85.7% for pronation and supination, respectively. The mean grip strength was 78.3% compared to the non-operated side. Eight patients were very satisfied, five patients were partly satisfied with the result. The DASH, PRWE, MHQ and Lyon-Scores averaged 39.1, 36.2, 64.9 and 63.3 points, respectively. The mean VAS-Score for pain was 1.1 at rest and 3.2 during activities. Perioperative complications included one dissection of the extensor pollicis longus tendon, one heterotopic ossification, one radiocarpal dislocation and two cases of an ulnar impaction syndrome due to implant subsidence.ConclusionThe prosthetic treatment of complex DRFs in elderly patients with the Cobra implant led to clinically and radiologically satisfactory mid-term results. The Cobra prosthesis still does not represent a gold standard but can be regarded as a feasible salvage option for complex DRFs when osteosyntheses may not be possible and non-operative treatment will lead to further functional restrictions and wrist pain during performing activities of daily life in high functional demand patients.

The spanning plate as an internal fixator in complex distal radius fractures: a prospective cohort study.

Minimal invasive temporary spanning plate (SP) fixation of the wrist has been described as an alternative treatment method in complex distal radius fractures (DRFs). The purpose of this study is to conduct an outcome analysis of all consecutive DRFs treated by SP fixation representing the so far largest published patient cohort outside the United States. Indication for SP fixation include DRFs with severe metaphyseal comminution, radiocarpal fracture dislocations with concomitant ligamentous injuries and very distal intra-articular fractures lacking the possibility of adequate plate anchoring. All consecutive patients undergoing SP fixation of DRFs were prospectively included in a single level I trauma centre between 01/01/2018 and 31/12/2020. For functional and patient-rated outcome analysis only patients who completed the 12month follow-up were included. In the mentioned timeframe, a total of 562 DRFs were treated operatively of which 28 underwent SP fixation. Average age was 58.1years (range 22-95years). The fracture type ranged from AO/OTA type B1.1 to C3.3 and included 8 fracture dislocations. SP removal was performed on average 3.7months after the initial operation (range 1.4-6.5months). Twenty-five patients completed the 12month follow-up (mean 14.5months, range 12-24). Radiological evidence of fracture healing appeared on average 9.9weeks (range 5-28weeks) after the initial operation. One patient experienced asymptomatic non-union. Mean radial inclination, volar tilt and ulnar variance at 1year were all within the acceptable limit predictive of symptomatic malunion. Complications included two patients with tendon rupture and one patient with extensor tendon adhesions needing tenolysis at the time of plate removal leaving an overall complication rate of 12%. There was no implant failure and no infection. Mean satisfaction score was 8.3 (range 4-10) and mean visual analogue scale for resting pain was 0.8 (range 0-5). The mean PRWE score was 17.9 (range 0-59.5) and the mean DASH score was 16.6 (range 0-60.8). Grip strength averaged 23kg (range 4-74kg) amounting to 68% of the opposite side. Range of motion regarding the extension/flexion, radial/ulnar abduction and pronation/supination arc reached 72%, 77% and 95% compared to the unaffected side, respectively. The radiological, functional and patient-rated outcomes in this study are remarkably good considering the complexity of the included fractures. Therefore, this method represents a valuable alternative for the treatment of complex DRFs in selected patients.

The spanning plate as an internal fixator in complex distal radius fractures – a prospective cohort study

Abstract Objective Minimal invasive temporary spanning plate (SP) fixation of the wrist has been described as an alternative treatment method in complex distal radius fractures (DRFs). The purpose of this study is to conduct an outcome analysis of all consecutive DRFs treated by SP fixation representing the so far largest published patient cohort outside the United States. Methods Indication for SP fixation included DRFs with severe metaphyseal comminution, radiocarpal luxation fractures with concomitant ligamentous injuries and very distal intra-articular fractures lacking the possibility of adequate plate anchoring. All consecutive patients undergoing SP fixation of DRFs were prospectively included in a single level I trauma centre between 01/01/2018 and 31/12/2020. Post-operative assessments included radiological, functional and patient-rated outcomes at a minimum of 12 months follow-up. Results In the mentioned timeframe, a total of 508 DRFs were treated operatively of which 28 underwent SP fixation. Average age was 58.1 years (range 22-95 years). The fracture type ranged from AO/OTA type B1.1 to C3.3 and included 8 fracture dislocations. SP removal was performed on average 3.7 months after the initial operation (range 1.4-6.5 months). The mean follow-up time was 14.5 months (range 12-24 months). Radiological evidence of fracture healing appeared on average 9.9 weeks (range 5-28 weeks) after the initial operation. One patient experienced oligosymptomatic non-union. Complications included 2 patients with tendon rupture and one patient with extensor tendon adhesions needing tenolysis at the time of plate removal leaving an overall complication rate of 12%. There was no implant failure and no infection. Mean satisfaction score was 8 (range 0-10) and mean visual analogue scale for resting pain was 0.9 (range 0-9). The mean PRWE score was 17.9 (range 0-59.5) and the mean DASH score was 16.6 (range 0-60.8). Grip strength averaged 23kg (range 4-74kg) amounting to 68% of the opposite side. Mean radial inclination, volar tilt and ulnar variance at 1 year were all within the acceptable limit predictive of symptomatic malunion. Conclusion The radiological, functional and patient-rated outcomes in this study are remarkably good considering the complexity of the included fractures. Therefore, this method represents a valuable alternative for the treatment of complex DRFs in selected patients.