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Use of a Distraction Plate for Distal Radial Fractures with Metaphyseal and Diaphyseal Comminution

¹ Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Winston-Salem, NC 27157. E-mail address for T.A. Ginn: tginn{at}wfubmc.edu
² Section of Hand and Microvascular Surgery, Department of Orthopaedics and Sports Medicine, University of Washington, Harborview Medical Center, 325 Ninth Avenue, Seattle, WA 98104

Investigation performed at the Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive 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.

Methods: Twenty-two patients treated with a distraction plate for a comminuted distal radial fracture were included in the study. With use of three limited incisions, a 3.5-mm ASIF plate was applied in distraction dorsally from the radial diaphysis, bypassing the comminuted segment, to the long-finger metacarpal, where it was fixed distally. The articular surface was anatomically reduced and was secured with Kirschner wires or screws. Eleven of the twenty-two fractures were treated with bone-grafting. The plate was removed after fracture consolidation (at an average of 124 days), and wrist motion was initiated. All patients were followed prospectively with use of radiographs, physical examination, and DASH (Disabilities of the Arm, Shoulder and Hand) scores.

Results: All fractures united by an average of 110 days. Radiographs showed an average palmar tilt of 4.6° and an average ulnar variance of neutral (0°), whereas loss of radial length averaged 2 mm. Flexion and extension averaged 57° and 65°, respectively, and pronation and supination averaged 77° and 76°, respectively. The average DASH scores were 34 points at six months, 15 points at one year, and 11.5 points at the time of final follow-up (at an average of 24.8 months). According to the Gartland-Werley rating system, fourteen patients had an excellent result, six had a good result, and two had a fair result. Grip strength and the range of motion of the wrist at one year correlated inversely with the proximal extent of fracture comminution into the diaphysis. The duration of plate immobilization did not correlate with the range of motion of the wrist or with the DASH score at one year.

Conclusions: The use of a distraction plate combined with reduction of the articular surface and bone-grafting when needed can be an effective technique for treatment of fractures of the distal end of the radius with extensive metaphyseal and diaphyseal comminution. A functional range of motion with minimal disability can be achieved despite a prolonged period of fixation with a distraction plate across the wrist joint.

Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

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Related articles in JBJS:

Use of a Distraction Plate for Distal Radial Fractures with Metaphyseal and Diaphyseal Comminution

T. Adam Ginn, David S. Ruch, Charles C. Yang, and Douglas P. Hanel
JBJS 2006 88: 29-36. [Abstract] [Full Text]  

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