Repositioning and stabilization of the radial styloid process in comminuted fractures of the distal radius using a single approach: the radio-volar double plating technique

Abstract

BackgroundA possible difficulty in intra-articular fracture of the distal radius is the displacement tendency of the radial styloid process due to the tension of the brachioradialis tendon.MethodsTen patients treated within one year for complex distal radius fractures by double-plating technique with a radial buttress plate and volar locking plate, through a single volar approach, were followed prospectively during 24 months. Outcome measures included radiographic follow-up, range of motion, grip strength and score follow-up (VAS, Gartland-Werley score and patient-rated wrist evaluation).ResultsTen patients with intraarticular distal radius fractures with dislocation of the radial styloid process were treated with this technique. This resulted after 24 months in good clinical outcome (mean visual analog scale 0.9; almost symmetric range of motion; mean Gartland-Werley score 2 ± 3; mean patient-rated wrist evaluation 3.2 ± 2.4). Radiologic evaluation according to the Dresdner Score revealed anatomic reduction without secondary dislocation during the follow-up and uneventful consolidation.ConclusionsThe described technique strongly facilitates anatomic reduction and stable fixation of intra-articular distal radius fractures with dislocation of the radial styloid process and leads to satisfactory clinical and radiographic outcome.

Complications of Radial Column Plating of the Distal Radius

“…To date, radial column plating has not been shown to be associated with a high risk of tendon rupture. 9,11,28 This is in contrast to dorsal plating techniques where it has been widely reported to have a high rate of extensor tendon ruptures. 13,23,24,26 Fitoussi et al 7 reported a 26% rate of complications when using a dorsal plating technique, including extensor tendon ruptures.…”

“…8,20 Jacobi et al concluded that "the radial plate used as a buttress plate, is a very useful tool to reduce a displaced radial styloid fragment in the frontal plane." 11 Since the first description, the contemporary technique has evolved considerably with anatomical plates placed along the radial border. 25,28 Reports of first-generation radial column plating were generally promising, and hardware removal rates were described as 23%.…”

“…16 However, other authors noted a much higher rate of 50%. 11 Helmerhorst and Kloen reported 2 out of 14 patients with hardware-associated complications, one patient sustained a loss of reduction and the other patient complained of a painful wrist. 9 Wei et al showed no clinically significant long-term differences between traditional volar plating and external fixation.…”

“…However, Jacobi et al reported 10 patients with complex distal radius fractures treated with VLPs and RCPs and, at 24-month follow-up, noted 5 patients complaining of “DeQuervain’s tendonitis-like” symptoms that eventually required hardware removal (~50%). 11…”

Double Plating of Distal Fibula Fractures

“…Double plating has been described in distal radius fracture open reduction internal fixation (ORIF), humeral shaft ORIF, and clavicle ORIF. [4][5][6] In this case, one plate is placed either straight lateral or anterolaterally and another is placed straight posterior or posterolaterally. The authors present a series of 12 patients with ankle fractures who underwent ORIF of a rotational distal fibula fracture using 2 one-third tubular plates for a variety of indications and present outcomes on those patients at a minimum of 1 year of follow-up.…”