Fragment-specific fixation for complex intra-articular fractures of the distal radius: results of a prospective single-centre trial

Abstract

The goal was to evaluate the efficacy of 2.4 mm column-specific plating for intra-articular distal radius fractures. In total, 105 patients with AO type C distal radius fractures were operated on using the locking distal radius system, Synthes. Follow-up assessments including clinical (wrist and forearm range of motion, grip strength), radiological (articular step, radial length and inclination, volar tilt, and ulnar variance), and functional scores (Disabilities of the Arm, Shoulder, and Hand; Patient Rated Wrist Evaluation) were made at regular intervals until 1 year. Union was obtained in all patients. Articular surface was anatomically reconstructed in 74 patients (70.5%). Clinical and functional evaluation showed significant continuous improvements over the first year. C1 fractures had a better chance of anatomical reduction compared with C2 and C3 fractures. Fracture type, quality of reduction, and presence of degenerative changes did not show a significant effect on functional outcome scores. Column-specific fixation of the distal radius can achieve satisfactory results in complex intra-articular fractures.

Type C distal radial fractures treated with conventional AO plates: an easy and cost-saving solution in a locking plate era

“…The improvement in ulnar variance, an important outcome indicator [32], shows that our study results can meet up to the aforementioned series. Finally, our re-intervention rates in these complex distal intraarticular fractures is acceptable and comparable to others [31]. However we must continue to search for possible ways and techniques to further refine our results.…”

“…Column-specific fixation of the distal radius seems essential to achieve satisfactory results in complex intra-articular fractures [30]. Some advocate the use of locking plates to reach this goal [31]. We believe, however, that this column specific stabilisation can be done adequately using ligamentotaxis and simple 2.7-mm AO plates to maintain reduction.…”

The Declining Use of Wrist-Spanning External Fixators

“…11 Although fragment-specific fixation has gained favor in treating intra-articular fractures of the distal radius, highly comminuted AO type C2 and C3 fractures have a lower likelihood of achieving anatomic reduction with either traditional volar locking plates or fragment-specific implants. 10,11,13 Despite the limitations of internal fixation, the refinement of implants used to treat comminuted distal radius fractures may be one of the factors driving the decreased use of external fixators. In addition, the development of radiocarpal distraction plate use, an alternative construct to external fixators that provides relative stability without the requirement of external hardware, may be a contributing factor in the decline of external fixation.…”

Intra-articular comminution worsens outcomes of distal radial fractures treated by open reduction and palmar locking plate fixation

“…For this reason, some have proposed a combined plating technique for comminuted intra-articular DRFs that includes a palmar locking plate because they believe that a single palmar locking plate alone is not adequate for reduction and fixation of all articular fragments (Farhan et al, 2015; Tang et al, 2010). However, Gavaskar et al (2012) reported that articular congruity could be achieved in just 70% of intra-articular DRFs, even though a combined plating technique was used. No study has compared the reduction status and wrist function in AO type C3 fractures treated by either single palmar plating or combined plating.…”

“…Although conservative treatment is widely used, operative management is currently favoured for comminuted intra-articular distal radial fractures (DRFs), because failure to reduce intra-articular fractures can lead to pain, limited range of wrist motion and post-traumatic arthritis (Axelrod and McMurtry, 1990; Bass et al, 1995; Bradway et al, 1989; Jupiter and Lipton, 1993; Knirk and Jupiter, 1986; Trumble et al, 1994). Management of DRFs has undergone radical change over the past two decades (Gavaskar et al, 2012). In particular, the advent of palmar locking plates has changed the surgical treatment and a single palmar locking plate is now frequently used for open reduction and internal fixation (Chung et al, 2006; Earp et al, 2015; Gruber et al, 2008).…”