Repositioning and stabilization of the radial styloid process in comminuted fractures of the distal radius using a single approach: the radio-volar double plating technique

Abstract

Background: A possible difficulty in intra-articular fracture of the distal radius is the displacement tendency of the radial styloid process due to the tension of the brachioradialis tendon.

Methods: Ten patients treated within one year for complex distal radius fractures by double-plating technique with a radial buttress plate and volar locking plate, through a single volar approach, were followed prospectively during 24 months. Outcome measures included radiographic follow-up, range of motion, grip strength and score follow-up (VAS, Gartland-Werley score and patient-rated wrist evaluation).

Results: Ten patients with intraarticular distal radius fractures with dislocation of the radial styloid process were treated with this technique. This resulted after 24 months in good clinical outcome (mean visual analog scale 0.9; almost symmetric range of motion; mean Gartland-Werley score 2 +/- 3; mean patient-rated wrist evaluation 3.2 +/- 2.4). Radiologic evaluation according to the Dresdner Score revealed anatomic reduction without secondary dislocation during the follow-up and uneventful consolidation.

Conclusions: The described technique strongly facilitates anatomic reduction and stable fixation of intra-articular distal radius fractures with dislocation of the radial styloid process and leads to satisfactory clinical and radiographic outcome.

Figure 1

Radial styloid dislocation and reduction. Dislocation of the radial styloid process is favored by the traction of the brachioradialis tendon. The radial buttress plate reduces displacement and neutralizes brachioradialis traction.

Figure 2

Radiologic evaluation. Radiologic evaluation according to the Dresdner Score included (i) volar inclination; (ii) radial inclination; (iii) loss of radial length and (iv) intraarticular steps.

Figure 3

Illustrated case (preoperative radiographs). Complex multifragmentary fracture of the distal radius with dorsal tilt.

Figure 4

Illustrated case (surgery). Intraoperative image with partially detached pronator quadratus muscle over the volar plate. The radial plate is visible on the radial border of the radius. (the image has been flipped horizontally for better comparison with the X-ray).

Figure 5

Illustrated case (postoperative radiographs). The fracture is anatomically reduced and stabilized.