gms | German Medical Science

Objectives/Interrogation: In complex distal radius fractures, combined volar and dorsal plating has been a less favourable option historically to many due to its complications.

Our goal was to evaluate radiological and functional outcome of combined dorsal and volar "sandwich" plating of distal radius using low-profile, titanium, fixed angle locking plate system (Variable angle LCP two-column volar/volar rim distal radius plate, DePuy Synthes;Acu-Loc dorsal distal radius plate, Acumed) in AO type C3 fractures.

Methods: 5 patients with closed distal radius fractures AO type C3 due to motor-vehicle accidents from September 2016 to September 2017 were managed surgically via combined dorsal and volar plating using the above implants(single volar and broad dorsal plate engaging radial and intermediate columns of the distal radius). Patient with brain injury was excluded. All cases were done by a single senior hand surgeon. Pre-operative CT wrist were performed. Pre- and post-operative wrist X-rays were evaluated. Clinical assessment of range of movement of the wrist, grip strength, QuickDASH questionnaire, Patient-rated Wrist and Hand Evaluation(PRWE) and Modified Mayo Wrist Score(MMWS) were done at 12 months post-op.

Results and Conclusions: Median age was 37 years (range 32 to 53). There were 4 males and 1 female. Mean follow up was 16.8 months. Mean time from trauma to surgery was 20.2 days. Mean pre-operative radial height was 3.6mm, radial inclination 8.8°, sagittal tilt -0.4°, intraarticular step was 3 mm. Mean post-op radial height was 11 mm, radial inclination 22.4°, sagittal tilt 1°, intra-articular step was 0 mm. No patient required bone grafting. Mean wrist movements post-op 1 year were flexion 62°, extension 58°, radial deviation 14°, ulnar deviation 15°, supination 78°, pronation 87°. Mean grip strength was 82% of the unaffected hand, corrected according to the 10% rule [1]. QuickDASH score was 4.96. PRWE was 16.6. MMWS was 81 (good). At 1 year follow-up, there was no loss of reduction noted. No hardware-related complication was reported and thus none required removal of implant. Patient self-reported average return to work with similar intensity was 6 months, mean self-reported satisfaction on visual analogue scores (0-10) was 7.4 (good).

We recommend "sandwich" plating for complex AO type C3 distal radius fractures. Both these plates provide excellent stability in maintaining the normal alignment of distal radius.We believe this is the first series reporting the "sandwich" technique using these two different plates.