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Bridge Plating For Distal Radius Fractures: A Prospective Functional Analysis
Alexander Lauder, MD; Sonya Agnew, MD; Christopher H. Allan, MD; Jerry I. Huang, MD
Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA

Introduction: Dorsal spanning distraction bridge plate fixation is used for surgical management of distal radius fractures in the setting of polytrauma, bilateral wrist injuries, and severely comminuted intra-articular distal radius fractures. It is currently unknown if placement of these plates for the duration of fracture healing has a long-term impact on wrist and hand function or kinematics. This study sought to determine the functional outcomes of patients following distraction bridge plate fixation of distal radius fractures.

Materials & Methods: The study population included all available adult patients over the age of 18 years who underwent treatment of a unilateral distal radius fracture with dorsal spanning bridge plate fixation from 2009 to December 2012. Patients greater than one year out from bridge plate removal were contacted for clinical follow-up for functional outcomes assessment. Wrist range of motion, composite finger flexion, grip strength, and wrist extension strength were measured and compared to the contralateral unaffected wrist. Patient also completed outcomes questionnaires (SF12, QuickDASH, PRWE).

Results: A total of 14 patients were available for follow-up and functional outcome assessment. The study group included nine men and five women with mean age of 60 (range 29 to 89). All patients had bridge plate removal within 5 months of the initial procedure. The mean grip strengths and extension torques were significantly decreased (85%, 80%) compared to the uninjured wrist. There was a significant decrease in grip strength (63 vs. 72 lbs, p = 0.002), wrist extension torque (88 vs. 102 lbs, p = 0.048), wrist flexion (44 vs 60 degrees, p=0.005) and ulnar deviation (24 vs. 30 degrees, p = 0.02). There was a trend towards decreased wrist extension (48 vs. 57 degrees, p = 0.10) and pronation (71.7 vs 74.1 degrees, p=0.182), that were not statistically significant. The mean DASH score was 12.3 and mean PRWE score of 10.8. There were no cases of infection, tendonitis, or tendon rupture.

Conclusions: Functional outcomes following distraction bridge plate fixation for distal radius fractures were similar to those published in the literature for volar plate fixation of similar distal radius fractures. There were minimal complications found in this cohort. Our findings suggest that this method is safe with minimal complications, and similar recovery to other methods of distal radius fixation is possible with rehabilitation.

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