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Does Dorsal Spanning Plate Fixation of Distal Radius Fractures Allow for Immediate Unrestricted Weight Bearing of Distal Radius Fractures?
Cameron Wallace, MD
1, Dylan Parsons, BS
1, Gretchen Maughan-Egbert, MSPH
2, Miranda J. Rogers, MD, MS
3; Nikolas H. Kazmers, MD, MSE
1(1)University of Utah, Salt Lake City, UT, (2)University of Utah Hospital, Salt Lake City, UT, (3)University of Michigan, Ann Arbor, MI
Introduction: It is unclear whether dorsal spanning plate (DSP) fixation can sufficiently maintain reduction in distal radius fracture (DRF) patients [1] when unrestricted weight bearing (UWB) is allowed immediately postoperatively. Our purpose was to 1) evaluate whether radiographic alignment is maintained in in this setting, and 2) to report related complications.
Methods: DRF patients at a single center who underwent open reduction and internal fixation (ORIF) between 2014-2024 were identified by CPT code. Inclusion criteria were confirmed through chart review and included: clearance for UWB immediately after DSP fixation, no concurrent ipsilateral extremity injuries/surgeries, and presence of intra-operative fluoroscopy images plus radiographs at ? five weeks postoperatively. Radiographic parameters were measured and compared using paired equivalence tests to determine whether loss of reduction occurred beyond the margin of measurement error as established in the prior literature.
Results: Of the 14 patients (15 DRFs), 57% (8/14) were female and the average age at injury was 56.4 (±11.8) years. All fractures were AO 23-B2 or greater. Five were polytrauma patients. The DSP bridged to the 3rd metacarpal in 10 cases, and 2nd metacarpal in five. The average time between index procedure and DSP removal was 12.1 (±4.2) weeks. All measurements were equivalent between five-week follow up and after DSP removal. However, UV and RH were not equivalent between intra-op and after DSP removal, differing by 1.33 and 0.4mm, respectively (Table 1). There were 0 revisions: ORIF, hardware failure, or nonunion. At the time of DSP removal, two patients required EIP to EPL transfer due to EPL rupture (14%; both attributed to plate irritation rather than plating over EPL).
Conclusion: UWB immediately after DSP fixation for DRFs is safe in terms of maintaining gross alignment parameters. Subtle collapse of the fracture may be visualized through changes in UV and RH as previously reported [1], though the clinical relevance of this is unclear. The benefits of DSP fixation must be balanced with the risk of complications including EPL rupture, although this is unlikely due to WB status.
[1] Guerrero, PMID: 31904607.
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