American Association for Hand Surgery

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Outcomes of Dorsal Wrist Bridge Plating for Distal Radius Fracture: A Retrospective Review
Kassem Ghayyad, MD1; Jonathan Xavier, MS1; Abdo Bachoura, MD1; Pedro Beredjikilian, MD2; Amir R Kachooei, MD1
1Rothman Orthopaedics Florida at AdventHealth, Orlando, FL; 2Thomas Jefferson University, Philadelphia, PA

Hypothesis: There is no difference in complication rate between fixation of the dorsal spanning plate to the 2nd versus 3rd metacarpal.

Methods: A query of the patients from 2018-2023 of a large multicenter institution was performed using Current Procedural Terminology (CPT) code for open treatment of distal radius and cross referenced against a query of a CPT code for implant removal to identify potential patients. Patient x-rays were then examined to identify bridge plating and the metacarpal used for fixation. Clinical outcomes recorded included Disabilities of the Arm, Shoulder, and Hand (DASH) score, range of motion, time to removal, and complications.

Results: A total of 147 patients were assessed, 76% were female, with a mean age of 68 ± 16 years. The plate related complication rate was 4.8 with five (3.4%) instances of plate breakage, one (0.7%) screw pullout, and one (0.7%) fracture collapse. All of the plates experiencing complications were affixed to the 2nd metacarpal. All of the plates with failure had central screw holes as part of their design. The average time to removal was 3.5 ± 2 months, and the average follow up was 6.6 ± 4 months. The DASH scores at final evaluation had a mean of 28 ± 22. The mean range of motion in flexion and extension were 47 ± 15 degrees and 50 ± 15 degrees respectively. The plate design had central holes 65% of the time. The bridge plate was affixed to the second metacarpal 92% of the time compared to the thirds 8%.

Summary Points:

Device related complication rate with dorsal spanning plate is 4.8%. Fixation to the second metacarpal is probably has a higher risk of plate failure. Dorsal wrist bridge plating to both 2nd and 3rd metacarpal can be performed effectively although fixation to the 3rd metacarpal is recommended with lower risk of plate failure.
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