Volar Buttress Plate Research Articles

Volar buttress plate fixation: An effective and reliable option for Bennett's fractures.

This study aimed to demonstrate the volar plate fixation technique for fixing Bennett's fractures due to its buttress effect. The retrospective study included 10 patients (8 males, 2 females; mean age: 35.9±11.56 years; range, 17 to 51 years) who were treated using the volar plate fixation technique between January 2018 and August 2022. The postoperative functional scores of the patients were evaluated using the Q-DASH (Quick Disabilities of the Arm, Shoulder, and Hand) score, and their pain status was evaluated with the Visual Analog Scale (VAS). We also assessed fracture union and development of complications. We assessed opposition according to Kapandji grade and abduction of the thumb. The mean follow-up time was 16.6±2.91 (range, 12 to 21) months. The technique was performed on the right extremity in eight patients and on the left extremity in two patients. All patients were right-hand dominant. The VAS score was 1 in two cases and 0 in the other cases. The mean Q-DASH score was 1.36±2.44. The mean pinch strength was 6.4±0.89 kg, and the mean grasp strength was 18.8±3.52 kg on the injured side. The mean Kapandji grade of opposition was 9.3±0.82, while the mean abduction degree was 37.4±2.01. Based on the early results of this technique, we conclude that volar plate fixation for Bennett's fractures is reliable and allows for early motion, providing anatomical and stable joint reduction, and it does not have implant complications such as hardware irritation. However, fixation of small fragments may be particularly challenging.

Outcome Of The Distal Radius Fractures Managed With Across Wrist External Fixator Vs Buttress Plates.

Distal radius fracture is one of the most common injuries presented to emergency department and can be presented in any age group. In young patients the most common cause is Road Traffic Accident (RTA), while old patient history of fall is the most common cause. Different surgical options are available to treat this injury. This study aims to compare the outcome of volar buttress plate vs across wrist external fixator for Arbeitsgemeinschaft für Osteosynthesefragen (AO) type C2/C3 fracture of the distal radius. A retrospective comparative study between July 2020 to June 2021 at Ghurki Trust Teaching Hospital was done and a total of 50 patients who underwent surgical intervention for AO C2/C3 fracture of the distal Radius, were included. The follow-up period was 12 weeks. QuickDASH score was used to find out patient's functional outcomes. Functional outcome was analyzed between the two groups using Mann-Whitney U test, using SPSS version 21. There was no significant statistical difference between the functional outcome of patients with distal radius fracture treated with across wrist external fixator vs volar buttress plate, in term of QuickDASH score. Furthermore, age and gender also were having no effect on functional outcome in our population. Across wrist external fixator is a reasonable option for AO C2/C3 type fractures of the distal radius with comparable results with volar buttress plate. It is the procedure of choice in high volume tertiary care hospitals like Gurki Trust Teaching hospital as it saves time, have similar functional outcome score, no need to re-open for removal of implant, less chances of tendon rupture as compared to volar buttress plate for distal radius fracture.

Prospective Descriptive Study of Radiological and Functional Outcomes of Volar Barton’s Fracture Fixed by Volar Locked Plate

BACKGROUND: Volar Barton’s fracture is a shearing mechanism of injury that results in fracture and subluxation of distal end radius in which volar rim of the distal radius is displaced with hand and carpus. Open reduction and volar plate fixation ensure more stable change of displacement, preservation of reduction, and early mobilization. AIM: This study aims to assess the functional and radiological outcome results of volar Barton’s fracture treated by volar buttress plate using the demerit points system of Gartland and Werley. PATIENTS AND METHODS: This study is a prospective descriptive observational study on 32 patients who were treated with ORIF by volar buttress plate for isolated volar Barton’s fractures between February 2018 and June 2020 in Alkindy teaching hospital/Baghdad/Iraq. All volar Barton’s fracture cases satisfying the inclusion criteria which included patient over 18 years, isolated fracture, medically fit, and <5 days old injuries, while fractures extend to radius shaft, compound fractures, and associated with other injuries were excluded from the study. All fractures are fixed by volar locked plate followed up for 12 week’s duration for functional and radiological assessment using the Demerit points system of Gartland and Werley. RESULTS: Most cases were in the age group below 40 years, average age 38 years (range 19–64 years), male patient was 69%, side of involvement was right wrist in 75% of cases, falling on an outstretched hand account 50%, while roads traffic accidents in 37.5%, fall from a height in 6.25%, and direct trauma in 6.25%. The final sequel of the results was average volar tilt was 11.1°, the radial shortening average was 4 mm, the radial inclination average was 19.9°, and the ulnar variance was 0.3 mm. Functional outcomes depending on Gartland and Werley’s score were 50% as excellent results, 43.75% as good results, 6.25% as fair results, and no poor results in this study. CONCLUSIONS: Volar locking buttress plate provides fracture stability and early mobilization, therefore, recovery of daily live activity in a short time.

Functional Outcome of Patients Undergoing Volar Buttress Plate for Fixation in Volar Barton’s Fracture of the Distal Radius

Introduction: Volar Barton’s fracture is a common problem among the distal radius fracture. Shearing fractures may involve the Volar articular margin is a displaced and inherently unstable fracture that may lead to pain, deformity, limited range of motion, and loss of hand function. In clinical practices, various methods are used for the management of Volar Barton’s fractures. The Volar buttress plate technique is now mostly chosen for the management of this type of fracture. The aim of the study was to observe the functional outcome of treating a Volar Barton’s fracture of the distal radius using a buttress plate. Methods: This prospective interventional study was carried out in the Department of Orthopaedic Surgery, BSMMU, Shahbag, Dhaka for the duration of 2 years 6 months (March 2014 to September 2016). Within this period 30 patients of Volar Barton’s fracture were selected as per inclusion and exclusion criteria who are admitted in this institution. After proper evaluation of these patients, open reduction and internal fixation were done with Volar locking buttress plate. Result: In this study, out of 30 patients 77% were male and 23%were female where the mean age was 32±9.3 and maximum incidence was between 18-39 years. Left side involvement was more 63% (19 patients) than right side involvement at 37% (11 patients). 7% of patients were found with superficial skin infections and treated non-operatively. In the final follow-up, 6.7% were obtained excellent scores, 73.3% were obtained good scores and 20% were obtained fair scores on the basis of anatomical outcome. Conclusion: The Volar buttress plate is found an effective technique of fixation. The Volar locking buttress plate maintained articular congruity, radial length, and alignment. The significant functional outcomes were observed at end of the final follow-up (24 weeks).

Volar plating versus external fixation for unstable dorsal fracture-dislocations of the proximal interphalangeal joint.

We retrospectively compared the results of volar plating and dynamic external fixation for acute unstable dorsal fracture-dislocations of the proximal interphalangeal joint with a depressed fragment. We treated 31 patients (31 fingers), 12 with volar buttress plating and 19 with dynamic external fixation. Follow-up averaged 35 and 40months in the two groups, with a minimal 6-month follow-up. Average active flexion of the proximal interphalangeal joint was 95° after plate fixation and 87° after external fixation, with an active extension lag of -6° and -9°, respectively. Active flexion at the distal interphalangeal joint averaged 67° in the plate group and 58° in the external fixation group, with active extension lags of 0° and -5°, respectively. We conclude that both methods can obtain a good range of motion at the proximal interphalangeal joint. A limitation of the extension of the distal interphalangeal joint occurred with dynamic external fixation but not with volar buttress plating.Level of evidence: IV.

Volar Buttress Plating for Dorsal Fracture-Dislocation of the Proximal Interphalangeal Joint With a Central Depressed Fragment: A Preliminary Report of 12 Cases

A preliminary report is presented of 12 patients with dorsal fracture-dislocations of the proximal interphalangeal joint with a central depressed fragment treated by volar buttress plating, with good results.

Distal radius fractures with unstable distal radioulnar joint treated by volar plate: A comparative study of immobilization versus early mobilization

BACKGROUND: Instability of distal radioulnar joint (DRUJ) following distal radius fracture is a treatment enigma with few options and uncertain outcome. Different studies have been conducted in this regard which came out with contradicting results. The aim of this study was to analyze whether immobilization of unstable DRUJ with above-elbow cast for 6 weeks has any advantages versus immobilization for 3 weeks similarly after anatomical fixation with volar plates.MATERIALS AND METHOD: We conducted a prospective study on patients with unstable distal radius fractures treated by open reduction with volar buttress plate from 2013 to 2016. Patients were grouped into Groups 1 and 2 depending on the postoperative immobilization protocol (each group with 21 patients). Group 1 patients were immobilized with above-elbow cast for 3 weeks and Group 2 patients for 6 weeks. Results were compared using wrist range of movements, patient-oriented Patient-Rated Wrist Evaluation (PRWE) and physician-based Sarmiento modified Gartland–Werley (GW) demerit scoring. All patients were evaluated for the persistence of DRUJ instability.RESULTS: Demographic data were comparable between the groups. AO type C fracture (67%) was common in both groups. The range of movements was comparable in both groups (P > 0.11). There was no statistically significant difference found in GW and PRWE scoring (P > 0.05). There were two patients with unstable DRUJ with decreased radial height and positive ulnar variance who needed further treatment.CONCLUSION: Prolonged immobilization (6 weeks) contributed no extra benefit when DRUJ is well reduced with anatomical fracture fixation. The instability recovered with healing of ligamentous injuries and fractures after stabilization of unstable bony fragments with surgical fixation of distal radius fracture.

Functional and radiological outcome of unstable distal radius fracture treated by conservative or volar buttress plate

Treatment of distal radius fracture is controversial; there is no single definitive treatment method that is considered the standard of care. It is important today to determine the nature of the fracture and to describe the bio-mechanism involved than to link diagnosis and treatment. This study involved total 50 patients, 18 cases were operated 32 were managed conservatively. Treatment to be received was decided by the patients themselves after thorough counseling about pros & cons of each modality, according to their financial status, activity level and associated comorbidities. Residual deformity PUS, RDT and RD in operative group were 11.11%, 5.55% and 11.11% respectively while in conservative group PUS, RDT and RD were 12.5%, 22.50% and 25.00% respectively.

Volar Plate Fixation to Treat Scaphoid Nonunion: A Case Series With Minimum 3 Years of Follow-Up.

Several options exist for treating scaphoid nonunion. For selected cases, some authors recommend using a volar buttress plate. The aim of the study was to report the clinical and radiological outcomes achieved at a minimum of 3 years' follow-up of treating scaphoid nonunion with a scaphoid volar plate. We retrospectively reviewed 15 patients with symptomatic scaphoid nonunion treated with scaphoid plate osteosynthesis and a bone graft from the volar aspect of the distal radius between January 2011 and November 2013. The patients' average age was 32 years (range, 21-62 years). No patient had undergone previous scaphoid surgery. Clinical assessments included wrist range of motion (ROM), grip strength, and a 10-point visual analog scale rating of pain. Further subjective assessment was performed using validated measurement tools. All patients underwent plain radiographywith 6 different views and computed tomography before and after surgery. The scapholunateangle was measured to evaluate carpal alignment. The mean follow-up period was 42 months (range, 36-51 months). Bone union was obtained in 13 of 15 patients (87%) at an average of 5 months (range, 3-8 months) after surgery. Significant improvements in the scapholunate angle and visual analog scale pain score were observed. However, both wrist ROM and grip strength remained significantly decreased relative to the opposite side (62% and 55% of normal, respectively). Four patients experienced hardware complications: plate breakage (1 scaphoid) and screw back-out (3 scaphoids). Impingement between the radial styloid and the scaphoid plate was identified in 6 patients. Five patients required additional surgery to remove the plate. Our study indicates unsatisfactory results treating scaphoid nonunion with a volar scaphoid plate. Although the rate of union was comparable with that of other series, we noted more complications. We are concerned about both the high proportion of hardware complications and required secondary surgical procedures. Therapeutic IV.

Lessons learned from volar plate fixation of scaphoid fracture nonunions.

IV.

Functional outcome of fixation of unstable distal end radius fracture with volar buttress plating, A prospective study

Background: Distal end of radius fracture accounts for 17% of all fractures in adults. The primary goal of treatment is to return the patient to his or her pre fracture functional status and to independent to carry out there daily needs. There are multiple options for distal end radius treatment, CRIF with K wire / external fixator, But there are disadvantages like malunion, pin tract infection, which may results in poor range of movement. Hence ORIF with volar plating is commonly done for unstable distal end radius. Materials and methods: In this study 30 patients with age above 18 years with distal end radius fractures treated with ORIF with volar plating. same post operative protocol, complications of surgery Intra operative and post operative were observed, functional outcome of all patients were recorded at regular follow up assessed with modified Gartlad & Werley’s wrist grading system.Results: In ORIF with volar plating, we noted patient with poor outcome of 10%, fair outcome of 23.33%, good outcome of 50% and excellent outcome of 16.67% at the end of 6 months. With mean range of movement Flexion =66.50, Dorsiflexion = 69.830, Radial deviation =18.830, Ulnar deviation =27.170, Pronation 700, Supination =72.670 and patient with satisfactory ROM with no complications. Conclusion: ORIF with volar plating is a successful procedure for distal end radius fractures. Early return to pre morbid level of activity and functions occurs very swiftly.

Biomechanics of Internal Fixation Modalities for Middle Phalangeal Base Fracture Dislocation.

Internal fixation modalities of unstable (>50 percent articular involvement) middle phalangeal volar lip fracture-dislocations include interfragmentary screw and volar buttress plating. This study investigates the mechanical properties (yield strength, ultimate tensile strength, and stiffness) of interfragmentary screw (IS), simple buttress plating (BP) and buttress plating with subchondral screw (BP+S). Fifteen cadaveric digits (5 index, 5 middle, and 5 ring) were prepared by excising its skin envelope and flexor tendons while preserving the structures around the proximal interphalangeal joint. An oblique osteotomy involving 50 percent of the articular surface was performed, and this was fixed with based on its study group: interfragmentary screw (IS), simple buttress plating (BP) and buttress plating with subchondral screw (BP+S). These specimens were then loaded to failure. Yield strength was as follows: BP+S (33.5±9.76 N), IS (13.6±5.46 N), and BP (8.1±3.84 N). Ultimate tensile strength was as follows: BP+S (49.1±21.4 N), IS (15.6±5.19 N), and BP (8.86±3.99 N). Stiffness was as follows: BP+S (4.77±1.32 N/mm), IS (2.44±0.86 N/mm), and BP (1.84±0.71 N/mm). A buttress plate and screw construct confers significantly more stability than either interfragmentary screw or buttress plate only fixation in an experimental model.

Scaphoid Plate Fixation and Volar Carpal Artery Vascularized Bone Graft for Recalcitrant Scaphoid Nonunions

We sought to evaluate the clinical and radiographic outcomes after treatment of symptomatic, recalcitrant scaphoid nonunions using a novel combination of volar scaphoid buttress plating with a pedicled vascularized bone graft. We retrospectively followed 9 patients with recalcitrant scaphoid waist nonunions, characterized by failed prior surgery, long duration of nonunion, avascular necrosis of the proximal pole, or considerable bone loss at the nonunion site. We treated these persistent nonunions through a single volar incision with a pedicled vascularized bone graft, based on the volar carpal artery, and a 1.5-mm precontoured, scaphoid-specific, volar buttress plate. Postoperatively, we assessed objective and subjective outcomes as well as radiographs and computed tomography scans. The median duration of nonunion was 15 months, ranging from 6 to 96 months. Postoperative follow-up ranged from 11 to 19 months. Computed tomography scans demonstrated union in 8 of 9 cases. Complications included 1 minor hematoma that spontaneously resolved. One scaphoid failed to unite, requiring revision surgery. Three patients experienced problems with the plate. One plate was removed from a patient who noted persistent clicking, and 2 plates have caused symptomatic clicking, likely requiring future removal. Eight of nine patients reported satisfaction with the procedure, with QuickDash scores averaging 8.2. We present a series of recalcitrant scaphoid nonunions treated with a novel technique of volar buttress plating and vascularized bone graft. In this series, we found a high rate of union, with consistent radiographic improvement and symptomatic relief. This procedure can be performed using a single incision and with minimal donor site morbidity. Volar plating of a scaphoid nonunion comes with the risk of articular prominence, but offers a new alternative to headless screw fixation. Our early results from this series are promising and support this protocol as a viable alternative for challenging nonunions. Therapeutic IV.

Dorsal Plating of Unstable Scaphoid Fractures and Nonunions.

Achieving stable fixation of displaced acute and chronic nonunited scaphoid fractures continues to be a challenge for the treating surgeon. The threaded compression screw has been the mainstay of treatment of these fractures for the last 3 decades; however, persistent nonunion after screw fixation has prompted development of new techniques. Recent results of volar buttress plating have been promising. We describe a novel technique of dorsal scaphoid plating. In contrast to volar plating, the dorsal plate is biomechanically more favorable as it utilizes the tension side of the scaphoid bone for dynamic compression. Dorsal scaphoid plating provides a more stable construct than the traditional Herbert screw and mitigates the need for vascular or corticocancellous bone grafting in most cases.

Displaced Intra-Articular Fractures Involving the Volar Rim of the Distal Radius

To describe the features of displaced intra-articular fractures confined to the volar rim of the distal radius and compare outcomes after their operative fixation to complete intra-articular and extra-articular fractures treated with operative fixation. A total of 627 distal radius fractures were treated over a 6-year period. Twenty-eight patients had volar rim fractures (type 23-B3, as classified by the Orthopaedic Trauma Association [OTA]), all treated with operative reduction and fixation using a volar buttress plate. Clinical outcome information including radiographs, Short Form-36 health survey, and Disabilities of the Arm, Shoulder, and Hand questionnaire were collected at regular postoperative intervals. Patients with volar rim fractures were compared with patients who sustained other types of operatively managed distal radius fractures (OTA types 23-A, 23-B1/B2, and 23-C). The most common type of volar rim fracture consisted of a single large fragment (OTA 23-B3.2; 46%), followed by comminuted fractures (OTA 23-B3.3; 36%). Restoration of radiographic parameters was similar between groups except for an increased volar tilt in volar rim fractures compared with group 23-B1/B2. Active wrist and finger motion improved in all groups except for wrist extension, which was less in the 23-B1/B2 groups. The 23-B1/B2 group had the greatest pain and worst Short Form-36 scores. Disabilities of the Arm, Shoulder, and Hand questionnaire scores were similar and without differences between groups. Our data suggest that patients with volar rim distal radius fractures can expect a rapid return to function with minimal risk for complications and have outcomes similar to other types of operatively treated distal radius fractures. Further investigation of type 23-B fractures (23-B1/B2) is warranted owing to evidence of diminished outcomes.

Volar Plate Fixation of Recalcitrant Scaphoid Nonunions With Volar Carpal Artery Vascularized Bone Graft

Chronic scaphoid fracture nonunion continues to present a significant challenge to the treating orthopedic surgeon. Internal fixation with threaded compression screws leads to high union rates, and is currently the gold standard, but there are certainly circumstances where a scaphoid screw does not provide the stability necessary for nonunion repair. Results using a volar buttress plate have been promising, but have not been described in conjunction with the use of vascularized bone graft. Vascularized bone grafts have been shown to be highly effective in achieving rapid and reproducible rates of union. We describe a novel combination of a vascularized volar distal radius wedge autograft pedicled on the volar carpal artery and volar buttress plating for salvage treatment of chronic scaphoid nonunion.

Comparative analysis of external and internal fixation in lower radial articular fractures

Background: The treatment of distal radial articular fracture is still controversial despite continue refinement in the treatment. Objectives: The study was done to compare the functional as well as radiological outcome of treatment of distal radius by the external fixation frame and internal fixation by plating. Materials and Methods: This prospective study was conducted in a tertiary care hospital of eastern India on 40 patients with distal radial articular fractures after taking clearance from the Institutional Ethical committee and informed consent of the patients. All cases of distal radial articular fractures were randomly assigned by computerized methods to two different treatment protocols: a) external fixation application and b) internal fixation application. The fractures were classified with Fernandez and Jupiter classification. Results: In the present study excellent results were obtained in all Fernandez type I fractures both in external fixation and internal fixation group. Excellent to good results were obtained in all Fernandez type II fractures both in external fixation and internal fixation group. In external fixation group, out of six type II fracture four (66%) had excellent result and two (33%) had good result. In internal fixation group out of nine type II fracture five (55%) had excellent result and four (45%) had good result. Mixed results were obtained in all Fernandez type III fractures (16) both in external fixation and internal fixation group. In external fixation group, out of eight type III fracture 3(38%) had excellent result, four (50%) had good result and one (12%) had fair result. In internal fixation group out of eight type III fracture six (75%) had excellent result and two (25%) had good result. The results indicate that in type III fractures internal fixation is a better option. Fair to poor results were obtained in Fernandez type V (3) fractures both in external fixation and internal fixation group. Results may be improved by early bone grafting and possible external fixation and internal fixation (combined fixation). Out of thirteen patients with biplanar JESS, eight (61%) had excellent results compared to uniplanar UMAX in which out of seven, patients three (42%), had excellent results. Conclusions: External fixation and volar buttress plate produce almost equivalent functional results in distal radial articular fractures, with volar buttress plate having better anatomical results than external fixation in the present study. With careful assessment, good surgical technique and early mobilization, the distal radial articular fractures can be effectively managed with predictably good outcome using either external fixation or volar buttress plate. Volar buttress plate can be more effective in type III Fernandez fractures, while UMAX is a better option for Fernandez type II fractures.

The Unstable Nonunited Scaphoid Waist Fracture: Results of Treatment by Open Reduction, Anterior Wedge Grafting, and Internal Fixation by Volar Buttress Plate

The purpose of this study is to evaluate the results of treatment of unstable nonunited scaphoid waist fracture by anterior wedge graft and internal fixation with the use of volar buttress plate and screws. Fourteen adult male patients with unstable nonunited scaphoid waist fracture with a humpback deformity were treated by reduction of the collapse deformity, insertion of anterior wedge graft, and internal fixation with the use of volar buttress plate and screws. The mean patient age was 26 years, and the mean duration of the nonunion before surgery was 16.5 months. The follow-up time ranged from 9 to 19 months (mean, 11 mo). Thirteen of the fourteen nonunions healed with sound radiographic union. Pre-existing avascular necrosis was a major adverse factor for achievement of union in one patient, even after a second bone-grafting procedure. Union was achieved in a mean of 3.8 months. Most of the patients had satisfactory correction of scaphoid deformity and the associated dorsal intercalated segment instability. Postoperatively, improvements were seen in the range of wrist flexion and extension, grip strength, and degree of dorsal intercalated segment instability. The results of the series suggest that the method of anterior wedge graft and internal fixation with the use of volar buttress plate and screws is effective for the treatment of unstable nonunited scaphoid waist fractures. Therapeutic IV.

Functional and radiological outcomes in distal radius fractures treated with a volar plate vs. an external fixator

Purpose To compare the functional and radiological results obtained in distal radius intraarticular fractures treated by means of internal fixation with a volar buttress plate vs. those treated with an external fixator. Materials and methods We performed a comparative retrospective study of two patient series: 36 distal radius fractures treated with a volar AO T 2.4/2.7 buttress plate and 40 fractures treated with Pennig's dynamic external fixator. We used Müller's AO-ASIF classification following the anteroposterior and lateral x-ray study. We collected data about patient characteristics, mechanism of injury and postoperative complications. Minimum follow-up was 10 months. We performed clinical and radiographic evaluations at the beginning, at 3 months and at the end of follow-up. We used Lidström's scale for the functional assessment. Results In the group treated with a volar buttress plate better results were obtained for ulnar inclination of the radius and volar inclination on the sagittal plane. In this group only one case was left with an intraarticular step-off greater than or equal to 3 mm, as compared with 6 cases in the group treated with external fixation. 80% of patients treated with a volar plate obtained excellent or good results on the Lidström scale, as compared with 72.5% in the external fixation group, there being no statistically significant differences between the two groups. 30% of patients treated with an external fixator developed complications during follow-up, as compared with 22.2% in the volar plate group. OR time in the volar plate group was 74 minutes on average, whereas in the external fixation group it was 42 minutes. Mean time to postoperative mobilization was 12 days in the volar plate group. In patients treated with external fixation, the fixator was dynamized at 40 days on average and withdrawn at 62 days on average. Conclusions Our study shows that both kinds of treatment seem to afford similar radiological and functional results. Direct reduction followed by volar buttress plate fixation seems to provide for a more stable sort of anatomical reduction. Nevertheless, such difference does not lead to better functional outcomes. Both methods of treatment present with an acceptable postoperative complications rate.

Resultado funcional y radiológico en fracturas de la extremidad distal del radio tratadas con placa volar frente a fijador externo

Purpose To compare the functional and radiological results obtained in distal radius intraarticular fractures treated by means of internal fixation with a volar buttress plate vs those treated with an external fixator. Material and method We performed a comparative retrospective study of two patient series: 36 distal radius fractures treated with an volar AO T 2.4/2.7 buttress plate and 40 fractures treated with Pennig's dynamic external fixator. We used Müller's AO-ASIF classification following the anteroporterior and lateral X-ray study. We collected data about patient characteristics, mechanism of injury and postoperative complications. Minimum follow-up was 10 months. We performed clinical and radiographic evaluations at the beginning, at 3 months anda t the end of follow-up. We used Lidström's scale for the functional assessment. Results In the group treated with a volar buttress plate better radiographic results were obtained. In this group only one case was left with an intraarticular step-off greater than or equal to 3 mm, as compared with 6 cases in the group treated with external fixation. Eighty percent of patients treated with a volar plate obtained excellent or good results on the Lidström scale, as competed with 72.5% in the external fixation group, there being no statistically significant differences between the two groups. Thirty percent of patients treated with an external fixator developed complications during follow-up, as compared with 22.2% in the volar plate group. OR time in the volar plate group was 74 minutes on average, whereas in the external fixation group it was 42 minutes. Mean time to postoperative mobilization was 12 days in the volar plate group. In patients treated with external fixation, the fixator was dynamized at 40 days on average and withdrawn at 62 days on average. Conclusions Our study shows that both kinds of treatment seem to afford similar radiological and functional results. Direct reduction followed by volar buttress plate fixation seems to provide for a more stable sort of anatomical reduction. Nevertheless, such difference does not lead to better functional outcomes. Both methods of treatment present with an acceptable postoperative complications rate.