CC BY-NC-ND 4.0 · J Wrist Surg 2022; 11(02): 134-144
DOI: 10.1055/s-0041-1735839
Scientific Article

Dorsal Plate Osteosynthesis in Simple and Complex Fractures of the Distal Radius: A Radiological Analysis of 166 Cases

Haval Ghafoor*
1   Hand Surgery, Kantonsspital Baselland, Liestal, Switzerland
,
Mathias Haefeli*
2   Hand Surgery, Kantonsspital Graubünden, Chur, Switzerland
,
Regula Steiger
1   Hand Surgery, Kantonsspital Baselland, Liestal, Switzerland
3   Orthopraxis Lusser, Allschwil, Switzerland
,
1   Hand Surgery, Kantonsspital Baselland, Liestal, Switzerland
4   Department of Biomedical Engineering and Physics, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
5   Department of Biomedical Engineering, Medical Additive Manufacturing Research Group, University of Basel, Allschwil, Switzerland
› Author Affiliations

Abstract

Background To report the radiologic outcome and rate of complications of open reduction and internal fixation (ORIF) using a dorsal plate fixation of simple and complex distal radius fractures in adult patients.

Methods Patients treated with dorsal ORIF of simple and complex distal radius fractures between December 2008 and April 2013 were included in this single-center retrospective study. Type of fracture, radiographic measurements, and complications were documented.

Results One-hundred and sixty-six patients/fractures were included. Restoration of radial inclination (22° ± 3°) was achieved in 38%. Radial height (14 ± 1 mm) was least likely to be restored to normal values postoperative in 25%. Normal ulnar variance (0.7 ± 1.5 mm) could be observed in 60% and adequate volar tilt (11° ± 5°) was achieved in 50% at final follow-up. We observed one loss of reduction in an AO type C2 fracture and a total of 15 nonimplant-related minor clinical complications.

Conclusion Our radiographic findings after dorsal plating are comparable to those published on volar plating. The changes in radial height and volar tilt could be attributed to projection-related differences in the radiographs and did not signify a loss of reduction in all cases.

Clinical Relevance Dorsal plating of distal radius fractures is safe and remains an important approach in the treatment of complex distal radius fractures. Complications in our study were even less compared to those reported in the literature.

Type of Study/Level of Evidence This is a Type IV study.

Level of Experience of Surgeons The level of experience of surgeons is III–V.

Ethical Review Approval

The study has been approved by the local ethical committee (EKNZ 2016–00303).


* These authors contributed equally.




Publication History

Received: 12 December 2020

Accepted: 03 August 2021

Article published online:
01 October 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Leung F, Zhu L, Ho H, Lu WW, Chow SP. Palmar plate fixation of AO type C2 fracture of distal radius using a locking compression plate–a biomechanical study in a cadaveric model. J Hand Surg [Br] 2003; 28 (03) 263-266
  • 2 Rein S, Schikore H, Schneiders W, Amlang M, Zwipp H. Results of dorsal or volar plate fixation of AO type C3 distal radius fractures: a retrospective study. J Hand Surg Am 2007; 32 (07) 954-961
  • 3 Ng CY, McQueen MM. What are the radiological predictors of functional outcome following fractures of the distal radius?. J Bone Joint Surg Br 2011; 93 (02) 145-150
  • 4 Martineau PA, Berry GK, Harvey EJ. Plating for distal radius fractures. Orthop Clin North Am 2007; 38 (02) 193-201 , vi
  • 5 Ruch DS, Papadonikolakis A. Volar versus dorsal plating in the management of intra-articular distal radius fractures. J Hand Surg Am 2006; 31 (01) 9-16
  • 6 Catalano III LW, Barron OA, Glickel SZ. Assessment of articular displacement of distal radius fractures. Clin Orthop Relat Res 2004; (423) 79-84
  • 7 Osada D, Viegas SF, Shah MA, Morris RP, Patterson RM. Comparison of different distal radius dorsal and volar fracture fixation plates: a biomechanical study. J Hand Surg Am 2003; 28 (01) 94-104
  • 8 Kamano M, Honda Y, Kazuki K, Yasuda M. Palmar plating for dorsally displaced fractures of the distal radius. Clin Orthop Relat Res 2002; (397) 403-408
  • 9 Orbay JL, Fernandez DL. Volar fixation for dorsally displaced fractures of the distal radius: a preliminary report. J Hand Surg Am 2002; 27 (02) 205-215
  • 10 Ruch DS, Weiland AJ, Wolfe SW, Geissler WB, Cohen MS, Jupiter JB. Current concepts in the treatment of distal radial fractures. Instr Course Lect 2004; 53: 389-401
  • 11 Hintringer W, Rosenauer R, Pezzei C. et al. Biomechanical considerations on a CT-based treatment-oriented classification in radius fractures. Arch Orthop Trauma Surg 2020; 140 (05) 595-609
  • 12 Tavakolian JD, Jupiter JB. Dorsal plating for distal radius fractures. Hand Clin 2005; 21 (03) 341-346
  • 13 Wei J, Yang TB, Luo W, Qin JB, Kong FJ. Complications following dorsal versus volar plate fixation of distal radius fracture: a meta-analysis. J Int Med Res 2013; 41 (02) 265-275
  • 14 Kambouroglou GK, Axelrod TS. Complications of the AO/ASIF titanium distal radius plate system (pi plate) in internal fixation of the distal radius: a brief report. J Hand Surg Am 1998; 23 (04) 737-741
  • 15 Rozental TD, Beredjiklian PK, Bozentka DJ. Functional outcome and complications following two types of dorsal plating for unstable fractures of the distal part of the radius. J Bone Joint Surg Am 2003; 85 (10) 1956-1960
  • 16 Schnur DP, Chang B. Arbeitsgemeinschaft für Osteosynthesefragen/Association for the Study of Internal Fixation. Extensor tendon rupture after internal fixation of a distal radius fracture using a dorsally placed AO/ASIF titanium pi plate. Ann Plast Surg 2000; 44 (05) 564-566
  • 17 Devaux N, Henning J, Haefeli M, Honigmann P. The retinaculum flap for dorsal fixation of distal radius fractures. J Hand Surg Am 2018; 43 (04) 391.e1-391.e7
  • 18 Kumar S, Khan AN, Sonanis SV. Radiographic and functional evaluation of low profile dorsal versus volar plating for distal radius fractures. J Orthop 2016; 13 (04) 376-382
  • 19 Pallaver A, Honigmann P. The role of cone-beam computed tomography (CBCT) scan for detection and follow-up of traumatic wrist pathologies. J Hand Surg Am 2019; 44 (12) 1081-1087
  • 20 Honigmann P, Frueh FS. Letter about a published paper. J Hand Surg Eur Vol 2018; 43 (04) 451
  • 21 Fernández DL. Fractures of the distal radius: operative treatment. Instr Course Lect 1993; 42: 73-88
  • 22 Meinberg EG, Agel J, Roberts CS, Karam MD, Kellam JF. Fracture and dislocation classification compendium-2018. J Orthop Trauma 2018; 32 (Suppl. 01) S1-S170
  • 23 Herzberg G. Acute distal radius fracture: PAF analysis. J Wrist Surg 2013; 2 (01) 95-96
  • 24 Jupiter JB. Fractures of the distal end of the radius. J Bone Joint Surg Am 1991; 73 (03) 461-469
  • 25 Mekhail AO, Ebraheim NA, McCreath WA, Jackson WT, Yeasting RA. Anatomic and X-ray film studies of the distal articular surface of the radius. J Hand Surg Am 1996; 21 (04) 567-573
  • 26 Mann FA, Raissdana SS, Wilson AJ, Gilula LA. The influence of age and gender on radial height. J Hand Surg Am 1993; 18 (04) 711-713
  • 27 Jung JM, Baek GH, Kim JH, Lee YH, Chung MS. Changes in ulnar variance in relation to forearm rotation and grip. J Bone Joint Surg Br 2001; 83 (07) 1029-1033
  • 28 Porter M, Stockley I. Fractures of the distal radius. Intermediate and end results in relation to radiologic parameters. Clin Orthop Relat Res 1987; (220) 241-252
  • 29 Mann FA, Wilson AJ, Gilula LA. Radiographic evaluation of the wrist: what does the hand surgeon want to know?. Radiology 1992; 184 (01) 15-24
  • 30 Medoff RJ. Essential radiographic evaluation for distal radius fractures. Hand Clin 2005; 21 (03) 279-288
  • 31 Altissimi M, Antenucci R, Fiacca C, Mancini GB. Long-term results of conservative treatment of fractures of the distal radius. Clin Orthop Relat Res 1986; (206) 202-210
  • 32 Knirk JL, Jupiter JB. Intra-articular fractures of the distal end of the radius in young adults. J Bone Joint Surg Am 1986; 68 (05) 647-659
  • 33 Lalone EA, Grewal R, King GJ, MacDermid JC. A structured review addressing the use of radiographic measures of alignment and the definition of acceptability in patients with distal radius fractures. Hand (N Y) 2015; 10 (04) 621-638
  • 34 Mignemi ME, Byram IR, Wolfe CC. et al. Radiographic outcomes of volar locked plating for distal radius fractures. J Hand Surg Am 2013; 38 (01) 40-48
  • 35 Clavien PA, Barkun J, de Oliveira ML. et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 2009; 250 (02) 187-196
  • 36 Synn AJ, Makhni EC, Makhni MC, Rozental TD, Day CS. Distal radius fractures in older patients: is anatomic reduction necessary?. Clin Orthop Relat Res 2009; 467 (06) 1612-1620
  • 37 Chen NC, Jupiter JB. Management of distal radial fractures. J Bone Joint Surg Am 2007; 89 (09) 2051-2062
  • 38 Rubinovich RM, Rennie WR. Colles' fracture: end results in relation to radiologic parameters. Can J Surg 1983; 26 (04) 361-363
  • 39 Trumble TE, Schmitt SR, Vedder NB. Factors affecting functional outcome of displaced intra-articular distal radius fractures. J Hand Surg Am 1994; 19 (02) 325-340
  • 40 Batra S, Gupta A. The effect of fracture-related factors on the functional outcome at 1 year in distal radius fractures. Injury 2002; 33 (06) 499-502
  • 41 Lee SJ, Park JW, Kang BJ, Lee JI. Clinical and radiologic factors affecting functional outcomes after volar locking plate fixation of dorsal angulated distal radius fractures. J Orthop Sci 2016; 21 (05) 619-624
  • 42 Chou YC, Chen AC, Chen CY, Hsu YH, Wu CC. Dorsal and volar 2.4-mm titanium locking plate fixation for AO type C3 dorsally comminuted distal radius fractures. J Hand Surg Am 2011; 36 (06) 974-981
  • 43 Catalano III LW, Cole RJ, Gelberman RH, Evanoff BA, Gilula LA, Borrelli Jr J. Displaced intra-articular fractures of the distal aspect of the radius. Long-term results in young adults after open reduction and internal fixation. J Bone Joint Surg Am 1997; 79 (09) 1290-1302
  • 44 Plant CE, Parsons NR, Costa ML. Do radiological and functional outcomes correlate for fractures of the distal radius?. Bone Joint J 2017; 99-B (03) 376-382
  • 45 Yu YR, Makhni MC, Tabrizi S, Rozental TD, Mundanthanam G, Day CS. Complications of low-profile dorsal versus volar locking plates in the distal radius: a comparative study. J Hand Surg Am 2011; 36 (07) 1135-1141
  • 46 Ring D, Jupiter JB, Brennwald J, Büchler U, Hastings II H. Prospective multicenter trial of a plate for dorsal fixation of distal radius fractures. J Hand Surg Am 1997; 22 (05) 777-784
  • 47 Chiang PP, Roach S, Baratz ME. Failure of a retinacular flap to prevent dorsal wrist pain after titanium Pi plate fixation of distal radius fractures. J Hand Surg Am 2002; 27 (04) 724-728
  • 48 Kamath AF, Zurakowski D, Day CS. Low-profile dorsal plating for dorsally angulated distal radius fractures: an outcomes study. J Hand Surg Am 2006; 31 (07) 1061-1067
  • 49 Letsch R, Infanger M, Schmidt J, Kock HJ. Surgical treatment of fractures of the distal radius with plates: a comparison of palmar and dorsal plate position. Arch Orthop Trauma Surg 2003; 123 (07) 333-339
  • 50 Matzon JL, Kenniston J, Beredjiklian PK. Hardware-related complications after dorsal plating for displaced distal radius fractures. Orthopedics 2014; 37 (11) e978-e982
  • 51 Rikli DA, Regazzoni P. Fractures of the distal end of the radius treated by internal fixation and early function. A preliminary report of 20 cases. J Bone Joint Surg Br 1996; 78 (04) 588-592
  • 52 Shaerf DA, Halsey TJ. Mechanical failure of the distal radius volar rim plate: a case report. J Hand Surg Eur Vol 2019; 44 (10) 1094-1096
  • 53 Honigmann P, Sutter D. Re: Shaerf DA and Halsey TJ. Mechanical failure of the distal radius volar rim plate: a case report. J Hand Surg Eur. 2019, 44: 1094-6. J Hand Surg Eur Vol 2020; 45 (05) 531-532