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The Journal of Bone and Joint Surgery (American) 86:1646-1652 (2004)
© 2004 The Journal of Bone and Joint Surgery, Inc.

Combined Dorsal and Volar Plate Fixation of Complex Fractures of the Distal Part of the Radius

David Ring, MD1, Karl Prommersberger, MD2 and Jesse B. Jupiter, MD1

1 Department of Orthopaedic Surgery, Massachusetts General Hospital, ACC 525, 15 Parkman Street, Boston, MA 02114. E-mail address for D. Ring: dring{at}partners.org
2 Karl Prommersberger, MD Klinik fur Handchirurgie, Salzburger Leite 1, D97615 Bad Neustadt, Germany

Investigation performed at Klinik fur Handchirurgie, Bad Neustadt, Germany, and Massachusetts General Hospital, Boston, Massachusetts

In support of their research or preparation of this manuscript, one or more of the authors received grants or outside funding from the AO Foundation (D.R. and J.B.J.). None of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: Fractures of the distal part of the radius that are associated with complex comminution of both the articular surface and the metaphysis (subgroup C3.2 according to the Comprehensive Classification of Fractures) are a challenge for surgeons using standard operative techniques.

Methods: Twenty-five patients with subgroup-C3.2 fractures that had been treated with combined dorsal and volar plate fixation were evaluated at an average of twenty-six months after the injury. Subsequent procedures included implant removal in twenty-one patients and reconstruction of a ruptured tendon in two patients.

Results: An average of 54° of extension, 51° of flexion, 79° of pronation, and 74° of supination were achieved. The grip strength in the involved limb was an average of 78% of that in the contralateral limb. The average radiographic measurements were 2° of dorsal angulation, 21° of ulnar inclination, 0.8 mm of positive ulnar variance, and 0.7 mm of articular incongruity. Seven patients had radiographic signs of arthrosis during the follow-up period. A good or excellent functional result was achieved for twenty-four patients (96%) according to the rating system of Gartland and Werley and for ten patients (40%) according to the more stringent modified system of Green and O'Brien.

Conclusions: Combined dorsal and volar plate fixation of the distal part of the radius can achieve a stable, mobile wrist in patients with very complex fractures. The results are limited by the severity of the injury and may deteriorate with longer follow-up. A second operation for implant removal is common, and there is a small risk of tendon-related complications.

Level of Evidence: Therapeutic study, Level IV (case series [no, or historical, control group]). See Instructions to Authors for a complete description of levels of evidence.


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