Radiographic Outcomes of Dorsal Spanning Plate for Treatment of Comminuted Distal Radius Fractures in Non-Elderly Patients

Abstract

Purpose: Multifragmentary fractures of the distal radius with articular and metaphyseal comminution (AO 23-C3) represent challenging injuries to manage. Distal fracture lines, articular comminution, and limited distal bone stock may preclude stable fixation with a volar locking plate. The use of a dorsal spanning plate (DSP) offers an alternative treatment option in this setting. We examined the radiographic outcomes of a consecutive series of patients with comminuted intra-articular distal radius fractures not amenable to volar locked plating, who were treated with a DSP.

Methods: We reviewed all distal radius fractures treated with a dorsal spanning plate at our institution between October, 2014 and March, 2018. Patients with AO 23-C3 fractures treated with dorsal spanning plate fixation were included in this study. Demographic data, time from plate placement to removal, and postoperative radiographic outcomes were examined.

Results: We identified 24 patients, mean age 41 years (range, 19-62 years). Mean follow-up was 19.5 weeks (range, 12-35 weeks) from the time of plate placement. Plates were removed at a mean of 87 days (range, 40-215 days) after surgery. All patients achieved radiographic union. Mean radial height at the time of union was 11.1 mm (SD, ±3.7 mm; range, 6-18 mm), radial inclination was 19.7° (SD, ±5.4°; range, 9° to 30°), ulnar variance was 1.0 mm (SD, ±2.4 mm; range, -3 to 6 mm), and volar tilt was 1.4° (SD, ±5.2°; range, -10° to 14°). Mean articular displacement was 1.7 mm (SD, ±1.7 mm; range, 0-6 mm). Malalignment of at least one of these radiographic parameters was identified in 16 of 24 patients at the time of union.

Conclusions: Dorsal spanning plate fixation offers an alternative treatment option for comminuted intra-articular distal radius fractures (AO 23-C3). Although this technique presents a straightforward means for fixation of complex distal radius fractures, radiographic outcomes may be inferior relative to less complex fractures treated with standard volar plating techniques.

Type of study/level of evidence: Therapeutic IV.

Keywords: Articular comminution; Distal radius fractures; Distraction plates; Dorsal spanning plate.

Figure 1

A, B Radiographs of a 36-year-old man with a right comminuted distal radius fracture after a fall off a 15-ft roof. C, D Fluoroscopic images of patient, who underwent treatment with a DSP 2 days later. E, F Radiographs were taken at 10 weeks after DSP placement. Final postoperative x-rays met acceptable criteria in 2 of 5 radiographic parameters (radial height and ulnar variance) with loss of sagittal alignment.

Figure 2

A, B Radiographs of a 48-year-old man with a comminuted right distal radius fracture who sustained a ground-level fall. C, D Fluoroscopic images of patient, who underwent treatment with DSP 4 weeks after the day of injury. E, F Radiographs were taken 6 weeks after DSP placement. Final postoperative x-rays reveal appropriate alignment in all 5 radiographic parameters.

Figure 3

A, B Radiographs of a 39-year-old man with a left comminuted distal radius fracture after a motorcycle accident. C, D Fluoroscopic images of patient, who underwent treatment with DSP placement 12 days after the injury. E, F Radiographs were taken 6 weeks after DSP removal. Final postoperative x-rays reveal malalignment in 3 of the 5 radiographic parameters (radial height, radial inclination, and articular stepoff).