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Bridging Plate for the Treatment of Distal Radius Fractures
Carlos Eduardo Saenz Pacheco; Eduardo Murilo Novak; Giana Silveira Giostri; Cartelli Daniel;
Ortopedia, Grupo de Cirurgia da Mão Hospital Universitário Cajuru - Pontificia Universidade Católica do Parana, Curitiba, Brazil

Objective: To evaluate the results of treatment of distal radial fractures presenting with severe comminution treated by the insertion ofÊa bridging extra-articular plate between the radius and the third metacarpal.

Methods: The results of 29 pacientes (30 radius), with ages between 19 e 79 years (at an average of 48.7 years), were analyzed afterÊsurgical treatment with a DCP 3,5 mm bridging extra-articular plate bypassing the cominuted segment, inserted through two limited incisions.ÊAditional K-wires were used whenÊsmall articular fragments demanded.ÊA second surgery was done after fracture consolidation for the removal of the hardware and joint manipulation (at an average of 2 months). ÊThe fractures were classified according to Fernandez and AO systemÊ(1 fracture type B3, 1 type C1, 8 type C2 and 20 type C3). The objective evaluation was performed by measuringÊthe range of motion of the wrist, grip strength, radiographic study and functional evaluation according to Gartland and Werley. The DASH questionnaire and an analogical pain scale were used to subjective evaluation.

Results: Follow-up time varied from 6 to 33 months, with a mean of 12,7 months. The mean time of radiographic consolidation was 8,7 weeks ranging from 6 to 23 weeks. The range of motion analysis showed 43¡ ± 13¡ (p<0,05) of wrist flexion, 45¡ ± 13¡ (p<0,05) of extension, 27¡ ± 9¡ (p<0,05) of ulnar deviation, 16¡ ± 6¡ (p<0,05) of radial deviation, 87¡ ± 5¡ (p<0,05) of pronation and 79¡ ± 14¡ (p<0,05) of supination. According to Gartland and Werley rating system,Ênone patient presentedÊwith a poor result, 15 hadÊregular, 10 had good and 5 had excellent results. The mean of radial angle was 19,1¡ ± 2,9¡, length of radius 9,2 ± 1,9 mm and volar angle 5,9¡ ± 6,4¡. The average of DASHÊscore (0 to 100) resulted 44,5 ± 51,2 points. Finally, 9 (30%) patients hadcomplications including two radial nonunions and two fracturesÊduring articularÊmanipulation.

Conclusion: The treatment of distal radial fractures with severe fragmentation by bridging the comminuted area with a plate can be effective, despite the prolonged period of treatment.

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