gms | German Medical Science

Objectives/Interrogation: Dorsal bridge plating has been used in complex comminuted intra-articular distal radius fractures (AO 23-C) as a means of supplemental fixation of poorly supported fracture fragments. This allows a fracture to be held out to length with a prolonged period of wrist immobilisation in order to allow healing and prevent collapse. The evidence regarding the use of dorsal bridge plating is limited to retrospective case series' in the literature. Most of these cases have utilised dorsal bridge plating as the primary means of fixation, ie as a distraction technique, without attempt at anatomical reduction and fixation of individual fragments. The aim of this study was to define the outcomes of patients with distal radius fractures treated with ORIF plus a supplemental dorsal bridge plate.

Methods: Two hundred and eighty-three distal radius ORIFs were performed by five senior hand surgeons in a single unit from 1 January 2016 to 31 December 2017. Of these, ten patients were identified as having an ORIF + dorsal plate placed as a neutralisation device. All of these fractures were type AO 23-C3. Average follow-up was 16.4 months post removal of the dorsal bridge plate. Intra-operative and most recent radiology was evaluated for radial inclination, volar tilt and ulnar variance. Objective measurements of forearm, wrist and digit range of motion and grip strength were recorded at last follow-up. Patients' subjective outcome measures were reported. This cohort of ten patients was compared to an age and gender matched group of ten patients treated by the same surgeons with ORIF only and 12 months follow-up (1 AO 23-C1, 3 AO 23-C2, 5 AO 23-C3).

Results and Conclusions: Mean radial inclination was 21 degrees with no difference at last follow-up. Volar tilt was lost in two patients (mean difference 1 degree). Ulnar variance was lost in four patients (mean difference -1 degree). ROM outcomes showed a statistically significant difference in flexion, extension and ulnar deviation when compared to uninjured wrist but no statistically significant measures when compared to the control group of patients. Mean active tip to distal palmar crease was 0.5cm. PRWHE was 22 ± 7 and QuickDASH was 18 ± 6 at final follow-up.

This is the first study that reports on outcomes of neutralisation bridge plating as a supplement to truly anatomical fixation with otherwise "standard" distal radius fixation techniques, and compares a bridge plate series to a case matched control group.