Management of Comminuted Distal Radius Fractures: A Critical Analysis Review

Adjunctive dorsal spanning plate fixation for challenging distal radius injuries

Background

Distal radius fractures with severely osteoporotic bone or articular comminution can provide challenges to fixation with traditional volar locked plating alone. The purpose of this study was to evaluate the clinical, radiographic, and patient reported outcomes of patients undergoing distal radius fixation with volar locked plating and adjunctive dorsal bridge plating.

Methods

We retrospectively identified 16 patients with distal radius fractures who underwent our preferred surgical technique for fixation. Patients underwent volar locked plate fixation as well as dorsal bridge fixation at time of surgery. Seven patients were indicated for severe articular comminution with volar rim fragmentation (44%), three patients were revised for nonunion after previous volar locked late fixation (19%), and six patients had severely osteoporotic bone with articular comminution (38%). Two patients (13%) sustained AO/OTA 23-A3 distal radius fracture, two patients (13%) had a 23-B3 fracture, two patients (13%) had a 23-C2 fracture and ten patients (63%) had a 23-C3 fracture.

Results

The average patient age was 51.8 years ± 20.6. Patients were followed for an average of 12.2±6.3 months. The dorsal bridge plate was removed at an average of 11.1±2.4 weeks. The average post-operative radial inclination was 18.9±2.4°, radial height 12.4 mm ± 2.6 mm, and volar tilt 7.1±1.9°. There were no cases of deep or superficial infection. After dorsal bridge plate removal, patients demonstrated an average wrist extension of 55.3±9.5°, flexion 54.4±12.8°, radial deviation 15.7±3.2°, 25.2±3.9 degrees of ulnar deviation.

Conclusion

Distal radius fractures in the setting of severely osteoporotic bone, salvage procedures, articular comminution, volar rim fractures, and revision surgery present uniquely difficult surgical challenges. Volar locked plating with adjunctive dorsal bridge plating can be used with good short- and long-term results.

Persian Fixation - A Novel Surgical Method for Intra-articular Distal Radius Fractures

Background: Intra-articular distal radius fracture treatment options include Kirschner wires (K-wire) fixation, external fixation and plate fixation, however, fixation of small bone fragments in distal radius fractures in a secure and anatomical manner was a challenging issue with several limitations. In this study, we present a novel surgical method that we have called the Persian Fixation for intra-articular distal radius fracture and describe a short-term clinical result. Methods: We described the surgical procedure and clinical result of 15 patients between 2019 and 2020 in whom the Persian Fixation technique was utilised. Through clinical examination and questionnaires, objective and subjective clinical results were determined. Results: At the final follow-up, the mean Quick Disabilities of the Arm, Shoulder and Hand (Quick-DASH) score for our patients was 17.6 ± 12.1, the mean WOrk-Related Questionnaire for UPper extremity disorders (WORQ-UP) score was 20.7 ± 4.4 and the mean Visual Analogue Scale (VAS) score was 27.8 ± 16.5, indicating a good to excellent clinical result. Conclusions: We recommended the Persian Fixation technique for intra-articular distal radius fractures, which is a low-cost and readily accessible procedure that provides stable fixation of a tiny bone piece. Level of Evidence: Level IV (Therapeutic).