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Theme: Inclusion and Collaboration Theme: Inclusion and Collaboration

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Radiographic and Clinical Outcomes of Distraction Bridge Plate Fixation for Complex Intra-articular Distal Radius Fractures
Genevieve M Rambau, MD; San Antonio Military Medical Center, San Antonio, TX; Peter Charles Rhee, DO, MS; Orthopaedic Surgery, San Antonio Military Medical Center, Fort Sam Houston, TX

Hypothesis: Distraction bridge plate (DBP) fixation for displaced intra-articular distal radius fractures can effectively reconstruct the distal radius with maintenance of acceptable radiographic parameters and restoration of function while allowing patients to begin early weight bearing for activities of daily living (ADL.)

Methods: A retrospective chart review was performed of all intra-articular distal radius fractures that underwent DBP fixation with or without additional fixation methods (e.g. fragment specific fixation, K-wires) at a Level-1 trauma center. Radiographic outcomes were volar tilt, radial height, inclination and articular step-off measured pre-operative, immediately following plate fixation, prior to plate removal, and post-operatively. Clinical outcomes assessed wrist range of motion and pain at final follow-up.

Results: Twenty-three comminuted, intra-articular distal radius fractures were treated with DBP fixation. Additional fragment-specific fixation included implants other than volar locking plates (n=5) or K-wires (n=5). Distraction bridge plates were removed a mean of 95 days (33.5 days) from the index procedure. There were significant improvements in intra-articular displacement (p = 0.002), volar tilt (p + 0.00005), radial height (p = 0.045) and inclination (p= 0.001) from pre-operative to post bridge plate removal for patients with unacceptable parameters at mean radiographic follow-up of 124 days ( 146). In all cases volar tilt was within 5 degrees of neutral or greater (5.5 5.5), radial height 11.3 ( 2.3), radial inclination 20.2 ( 4.4), and step-off less than 2.0mm (0.6 .8) At a mean clinical follow-up of 11.4 weeks ( 83 days), mean wrist and forearm motion was flexion to 29 degrees, extension to 33 degrees, pronation to 80 degrees, and supination to 61 degrees with an average pain level of less than 1/10 on the pain scale (0.85 1.36). Complications included 1 plate breakage and 1 patient who sustained a fracture proximal to the plate; both over 6 weeks from index surgery.

Summary Points:

  • Distraction bridge plate fixation with or without additional fixation methods can be used to effectively reconstruct complex, intra-articular distal radius fractures.
  • Although wrists are immobilized for a prolonged period of time, functional wrist and forearm range of motion can be restored after DBP removal with minimal residual pain.
  • The use of DBP permits early weight bearing to facilitate performing ADLs.
  • Caution must be maintained with early mobilization after DBP fixation to prevent plate breakage and perihardware fractures.
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