Management of Intra-Articular Distal Radius Fractures: Volar or Dorsal Locking Plate-Which Has Fewer Complications?

Abstract

Background: The aim of this study was to compare the functional outcomes and complications of volar and dorsal plating for the management of intra-articular distal radius fractures, with special regard to indications for dorsal plating. Furthermore, we examine the rationale for choosing dorsal plating and its frequency of use.

Methods: Clinical assessments included range of motion measurements at the wrist; grip strength; the Quick Disabilities of the Arm, Shoulder, and Hand score; and the Gartland and Werley score. Clinical results were compared with those achieved using a volarly placed locking plate system. According to Lutsky's plate theory, the rationale for choosing dorsal plating was based on 4 types of pathologic fractures.

Results: Of 112 patients, 38 patients were treated with open reduction internal fixation via a dorsal approach and 68 patients were treated using a volar approach. Except for wrist flexion, there were no other statistical differences in the clinical results between groups for both subjective and objective parameters. There were no statistically significant differences in the complication rates between the volar and dorsal plated groups. One serious complication occurred after volar plating. The most common reason for choosing dorsal plating was irreducible dorsal die-punch fractures.

Conclusions: The treatment of displaced intra-articular distal radius fractures with a dorsally versus a volarly placed interlocking plate system demonstrated similar clinical results. Postoperative complications were not readily observed in the patients treated with a dorsal locking plate. Certain fracture patterns are more appropriately stabilized using a dorsal plate fixation.

Keywords: complications; distal radius fracture; dorsal approach; intra-articular fracture; locked plate fixation.

Figure 1.

Posteroanterior and lateral radiographs of a 46-year-old male who sustained a fracture with an associated scapholunate ligament injury.

Figure 2.

Posteroanterior and lateral radiographs taken after the patient was treated using internal fixation with dorsal distal plating (Aptus 2.5 TriLock Distal Radius Plates; dorsal) and a radiocarpal external fixator. Note. The scapholunate ligament was repaired with a suture anchor simultaneously via a dorsal approach.

Figure 3.

The case of a 69-year-old woman. Note. The patient had implant removal surgery 10 months after open reduction and internal fixation for a distal radius fracture with volar plating (Aptus 2.5 TriLock Distal Radius Plates; volar). Intraoperative tendon damage was sustained by the flexor policis longus.

Figure 4.

Posteroanterior and lateral radiographs of a 67-year-old female who sustained a fracture with secondary displacement and significant dorsal comminution in which a volar fracture margin was more distal to the watershed line.

Figure 5.

Immediate postoperative, posteroanterior, and lateral radiographs of the same patient after internal fixation with a dorsal plate osteosynthesis (Matrix-SmartLock) and a radiocarpal external fixator: An iliac bone graft was applied into the resulting defect.

Figure 6.

Posteroanterior and lateral radiographs of a 46-year-old male who sustained dorsal die-punch fractures.

Figure 7.

Immediate postoperative, posteroanterior, and lateral radiographs of the same patient after internal fixation with column plates (Synthes 2.4-mm Locking Compression Plate Distal Radius System; dorsoradial and dorsoulnar).