Combined Volar and Dorsal Plating for Distal Radius Fractures using a Dorsal Frame Plate, a Consecutive Series of 74 AO type C Cases
Marcus Sagerfors, MD, PhD, Eva Lundqvist, MD and Patrik Bjorling, MD, Orebro university, Orebro, Sweden
Introduction: The distal radius fracture (DRF) is the most common fracture in adults. For unstable intra-articular fractures, the choice of treatment is often operative. The type of operation and optimal choice of implant remains a matter of discussion.
Materials and Methods: In a retrospective cohort study, following ethical approval, we evaluated 74 consecutive patients operated with combined plating using a volar plate and a dorsal frame plate (Medartis AG.). The DRFs were operated between 2016 and 2017. All cases were AO type C fractures. The primary outcome was patient reported outcome measures including radiographic examination one year postoperatively. Secondary outcome measures included wrist range of motion, VAS pain-scores and hand grip-strength.
Results: The median Batra radiographic score was 88. Median wrist extension was 76 % of the uninjured side, flexion was 74 %, pronation was 94 % and supination was 94 %. The Patient-Rated Wrist Evaluation-score was 18 points, the Disabilities of the Arm, Shoulder and Hand-score was 14.8 points. VAS-pain scores were 0 at rest and 2 during activity. Hand grip-strength was 82 % compared to the uninjured side. There were no tendon ruptures. Hardware removal was performed in 21 of the 74 patients. The radiographic outcome according to Batra did not correspond to the patient-reported outcome.
Conclusions: A good functional and radiographic outcome can be anticipated after combined plating of AO type C DRFs. The radiographic outcome does not necessarily correspond to the functional outcome one year postoperatively. The frequency of hardware removal was acceptable. Complex intra-articular distal radius fractures AO type C can be managed with combined volar and dorsal frame-plate fixation to restore distal radius anatomy.
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