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Dorsal Spanning Plate Malreduction of Distal Radius Fractures and the Impact on Forearm Rotation
Miranda J. Rogers, MD, MS1, John T Heineman, MD, MPH1, Suzanna Ohlsen, MD1, Scott Telfer, Eng.D.1, James Nolan Winters, MD2 and Nicholas Iannuzzi, MD1, (1)University of Washington, Seattle, WA, (2)Institute for Plastic Surgery, University of Washington, Seattle, WA

Hypothesis: Dorsal spanning bridge plate application can be used to manage complex distal radius fractures.1 The primary aim of this study is to evaluate the effect that rotational malreduction of a distal radius fracture may have upon pronation and supination of the forearm when using a dorsal spanning plate. We hypothesized that fracture malreduction would reduce pronation and supination in a cadaveric model.

Methods: Osteotomies of the distal radius were created in five cadaveric specimens. Specimens were stabilized in varying degrees of rotation using a dorsal spanning plate. Specimens were then mounted to a robotic testing system. An anatomical joint coordinate system was defined, and a force control algorithm was used to apply pronation and supination moments while minimizing forces and moments in other directions. Specimens were initially tested intact, followed by the different levels of malreduction including 15º and 30º of supination and 15º and 30º of pronation. A linear mixed effects regression model was used with motion variables modeled as the dependent variable, the surgical condition as the fixed effect, and specimen and specimen-condition interactions as random. Pairwise comparisons were performed with Tukey’s range test used to correct for multiple comparisons.

Results: Mean age was 70.6±4.5 years in the five cadavers. Baseline forearm rotation before osteotomy was 94.1º (8.1º) of supination and 88.1º (6.0º) of pronation. Forearm rotation was significantly impacted by malreduction. With 30º malreduction in supination, supination was significantly reduced by 8º (p<0.05). With 30º malreduction in pronation, pronation was significantly reduced by 6º (p<0.05). Malreductions of 15º supination or pronation did not significantly impact forearm rotation.

Summary Points:
· Rotational malreduction of ≤15º did not significantly restrict forearm range of motion.
· Large degrees of malreduction (≥30º) can result in significant restriction to forearm range of motion.
· Given the amount of bony malreduction required to reduce motion in this study, stiffness noted after dorsal spanning plate fixation may be secondary to soft tissue contracture or malalignment in other planes. Postoperative therapy continues to have an important role in recovery after spanning plate application.

Level of Evidence: Level IV, Prognostic

1. Lauder A, Agnew S, Bakri K, Allan CH, Hanel DP, Huang JI. Functional Outcomes Following Bridge Plate Fixation for Distal Radius Fractures. J Hand Surg Am. Aug 2015;40(8):1554-62. doi:10.1016/j.jhsa.2015.05.008.

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