Carpal Translocation Following Dorsal Bridge Plate Fixation of Distal Radius Fractures: A Cadaveric Study

Dorsal Bridge Plating for Comminuted Distal Radius Fractures: Functional Outcomes of Distal Fixation on 2nd Metacarpal versus 3rd Metacarpal

Purpose

To compare the functional outcome of distal fixation on the second metacarpal versus the third metacarpal in patients treated with dorsal bridge plating for comminuted intra-articular distal radius fractures.

Materials and Methods

The functional outcome of 60 patients treated with dorsal bridge plating was assessed 6 months postoperatively comparing distal fixation on the second metacarpal versus the third metacarpal. Pain, ability to work post-fixation, range of movements, stiffness, and grip strength were the parameters assessed.

Results

Distal fixation on the third metacarpal resulted in more stiffness and risk of tendon entrapment of the first and third extensor compartments when compared to distal fixation on the second metacarpal.

Conclusion

Dorsal bridge plating with a distal fixation on the second metacarpal shower better functional outcome compared to the third metacarpal with a better range of movements, less risk of tendon entrapment, and better fracture stabilization.

Distal Radius Fractures and the Dorsal Spanning Plate in the Management of the Polytraumatized Patient

Distal radius fractures are some of the most common fractures treated by the orthopaedic surgeon. There are a variety of methods of fixation to treat these fractures; however, in patients with polytrauma and in high-energy fracture patterns, fixation options can be limited. In the past, these fractures were treated with plaster, Kirschner wires, or external fixators that were fraught with complications. The dorsal spanning plate is an excellent option in the treatment of high-energy fractures and patients with polytrauma, fractures with dorsal or volar comminution, fracture dislocations, and shear injuries, and in geriatric patients with poor bone quality. The dorsal spanning plate not only allows for fixation of these complex fractures but also allows for weight-bearing through the wrist, an advantage for patients with concomitant lower extremity fractures and geriatric patients who need mobility aides. Understanding the risks and benefits of dorsal spanning plates and their use for the treatment of polytraumatized patient is a vital base of knowledge for the orthopaedic traumatologist.

Analysis of the Clinical and Radiological Results of Bridge Plate Versus External Fixation in Comminuted Distal Radius Fractures

Objective  To evaluate and compare the clinical and radiological outcomes of patients with comminuted distal radius fractures treated with an external fixator or a dorsal bridge plate. Methods  In total, 45 patients were analyzed 1 year after surgery; 18 were treated with an external fixator, and 25 received a dorsal bridge plate. An analog pain scale and the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire were applied, in addition to radiographic, strength and range of motion assessments. Statistical analyzes were performed using the chi-squared test and the Mann-Whitney non-parametric test. Results  Fractures were more common in women over 60 years old who suffered falls from their own height. Both methods demonstrated similar functional and radiological results. Infections were more prevalent in patients receiving external fixators, but their residual grip strength was better. Reflex sympathetic neuropathy was more common in subjects treated with a dorsal bridge plate. Conclusion  Our analysis showed no consensus on the superiority of one method over the other. Each method had advantages and disadvantages, but both led to good, similar outcomes. The treatment must be chosen according to the profile of the trauma, the patient's clinical conditions, the surgeon's experience, and the availability of materials.