Session IX - Upper Extremity

*Combined Dorsal and Volar Plate Fixation of Complex Fractures of the Distal Radius

David Ring, MD; Karl J. Prommersberger, MD; Amit Gupta, MD; Todd Morgan, BA; Jesse B. Jupiter, MD, Massachusetts General Hospital, Boston, MA (all authors ­ a-AO Foundation)

Purpose: As the understanding of distal radius-fracture patterns improves and the merits of fragment-specific fixation become apparent, it has proved useful to consider combined dorsal and volar plate fixation of some complex articular fractures.

Methods: Forty-one complex articular fractures of the distal radius were treated with combined dorsal and volar plate fixation. There were 29 male and 12 female patients with an average age of 45 years. In addition to complex comminution of the articular surface, the feature that distinguished all of these injuries was a split of the lunate facet in the coronal plane and combined volar and dorsal metaphyseal comminution.

Results: At an average follow-up of 22 months, all of the fractures had healed. There were no instances of plate loosening or breakage and no loss of reduction. Wrist extension averaged 53°, flexion 48°, supination 71°, and pronation 80°, and grip strength averaged 70% of that of the opposite side. According to the rating of Gartland and Werley, there were 5 excellent results, 34 good results, and 2 fair results.

Discussion and Conclusions: A separate volar exposure is often necessary for the treatment of complex articular fractures of the distal radius when the lunate facet is split in the coronal plane. In the presence of complex metaphyseal fragmentation, combined dorsal and volar plate fixation of the distal radius may be appealing. The functional results in our patients were good, considering the severity of the injuries, and there were no adverse effects related directly to the combined dorsal and volar internal fixation.