gms | German Medical Science

Objectives/Interrogation: Intra-articular dorsal distal radius fractures were conventionally treated with volar plating. Recent studies desbribed the use of dorsal plating but mostly preferred fragment specific plates [1].

Our goal was to evaluate the early outcome of broad dorsal plating of distal radius using low-profile, titanium, fixed angle locking plate system (Acu-Loc dorsal distal radius plate, Acumed) in AO C2 and C3 types of fractures.

Methods: 7 patients with distal radius fractures AO types C2 and C3 due to motor-vehicle accidents from 2015 to 2017 were managed surgically via dorsal plating using the above plate (broad dorsal engaging both radial and intermediate columns). Patient with brain injury was excluded. All surgeries were done by a single senior hand surgeon. Pre-operative CT wrist were performed. Pre- and post- operative wrist AP and lateral X-rays were evaluated. Clinical assessment of range of movement of the wrist, grip strength, QuickDASH, Patient-rated Wrist and Hand Evaluation (PRWE) and Modified Mayo Wrist Score (MMWS) were done at 12 months post-op.

Results and Conclusions: All patients were male. Median age was 27.6 years (range 15 to 59), 3 with AO type C2 and 4 AO type C3. Mean follow up was 28.4 months. 3 patients were referred after initial wrist external fixator application for dorsal subluxation, 1 of them was an open fracture Gustilo grade 1. Mean time from trauma to plating was 20.8 days, mean from external fixation to plating was 9.7 days. Mean pre-plating radial height was 7.3 mm, radial inclination 14.3°, sagittal tilt -4.7°, intra-articular step was 4.6 mm. Mean post-op radial height was 11.4 mm, radial inclination 19.1°, sagittal tilt 0.6°, intra-articular step was 0.5 mm. 2 patients required iliac bone grafting. Mean wrist movements post-op 1 year were flexion 60°, extension 59.3°, radial deviation 27.9°, ulnar deviation 27.9°, supination 85.7°, pronation 85.7°. Mean grip strength was 89.6% of the unaffected hand, corrected according to the 10% rule. QuickDASH score was 4.5, PRWE was 13.5, MMWS was 87.5 (good). At 1 year follow-up, there was no loss of reduction, no bone graft donor site or hardware-related complication and thus none required removal of implant. Patient self-reported average return to work with similar intensity was 4.5 months, mean self-reported satisfaction on visual analogue scores (0-10) was 8.1 (good).

We conclude that single broad dorsal plating is effective in treating AO type C2 and C3 distal radius fractures.