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Radiographic Outcomes of Dorsal Spanning Plate for Complex Distal Radius Fractures
Eric G. Huish, DO1; Sahil Vohra, BS2; Tony Bouz, BS2; Mohamed Ibrahim, MD1; Marc A. Trzeciak, DO1
1Valley Orthopedic Surgery Residency, Modesto, CA, 2Western University of Health Sciences, Pomona, CA
Introduction: Dorsal plating of distal radius fractures has mostly given way to locked volar plating. However, when the dorsal rim is fractured and depressed the carpus is often unstable and fragments may be too small for volar plate fixation. This is termed dorsal marginal impaction. Historically these are treated with external fixation. This bulky instrumentation has risk for pin-site infections while poorly managing volar tilt. An alternative is dorsal plating using a spanning/distraction plate. This technique reduces via ligamentotaxis and may be augmented by k-wires, bone graft, or additional hardware. The approach allows visualization of the joint surface. With this technique good radiographic outcomes are achievable.
Methods: 19 patients age 47.8 (22-82) with dorsal distraction plating for distal radius fractures were examined. These included 7 dominant and 12 non-dominant extremities. The procedures included direct joint visualization for reduction. Distraction across the radiocarpal joint reduces via ligamentotaxis. Reduction augmented with k-wires, plates, anchors, or bone graft as needed. Plates were removed after union, 80.5 days (54-123). Radiographs were performed at latest follow up.
Results: All fractures united prior to plate removal. There were no infections or tendon ruptures. Radiographs showed radial inclination of 20.5¡ (13.2-25.5¡), volar tilt of 7.9¡ (-3-15¡), and radial height of 10.7 mm (7.5-14 mm).
Discussion and Conclusion: Volar plating for dorsal marginal impaction may cause malreduction or carpus instability. Benefits of dorsal approach include direct joint visualization and creation of buttress. Stability is greater than ex-fix (Wolf 2006) due to shorter working distance. Polytrauma patients may weightbear with crutches, while avoiding the reported 62% complication rate of ex-fix (Weber 1986). With the construct beneath the skin there is no risk of pin-site infections seen with ex-fix. K-wires augmenting fixation can be removed if concerning for pin-site issues with most fixation remains. Maintaining volar tilt is difficult with ex-fix (Brogan 2015), but in our series it was maintained. Others have reported maintenance of volar tilt with this technique and decreased but functional ROM (Richard 2012, Ruch 2005). There is loss of flexion, extension, and ulnar deviation (Lauder 2015). Lauder showed grip strength improved more in dominant extremity injuries while Ruch showed an inverse relationship between grip strength and duration of fixation. Our plate duration of 80.5 days was less than theirs of 124 days. We anticipate shorter plate duration will allow greater ROM and strength at long-term follow-up.
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