Palmar locking plate for treatment of unstable dorsal dislocated distal radius fractures

This study investigates the clinical and radiological results of open reduction and internal fixation of unstable distal radial fractures using a palmar placed interlocking plate system with no substitutes for treatment of the dorsal metaphyseal fracture void.

Nineteen patients with a mean age of 61 years (range 49-78 years) and a dorsally displaced distal radial fracture were treated using a palmar placed 2.4 mm interlocking plate system. All 17 women and 2 men were followed up according to the study protocol. Standardised radiographs in anteroposterior and lateral projection were performed before reduction and at 2, 6, 12 and 24 weeks after surgery. Radiological measurements included palmar tilt, radial inclination and radial shortening as defined by ulnar variance and intra-articular steps. Clinical assessment included active range of motion (ARM) of the wrist, pain according to a visual analogue scale (VAS), grip power, working ability, Disability of Arm, Shoulder and Hand-Score (DASH Score) and Mayo Wrist Score.

At final follow-up after a minimum of 11 months, the palmar tilt was +1 degrees , radial inclination 19.8 degrees and ulnar variance 1.0 mm. Mean loss of palmar tilt measured 1.9 degrees , radial inclination 1.3 degrees and ulnar variance 0.4 mm. Mean wrist extension measured 58 degrees , wrist flexion 41 degrees , pronation 83 degrees and supination 84 degrees . The Mayo Wrist Score showed 21% excellent, 58% good, 16% fair and 5% poor results.

The treatment of unstable, dorsally dislocated, distal radius fractures AO types A3, C1 and C2, with a palmar placed 2.4 mm interlocking plate system and without additional treatment of the metaphyseal defects showed good radiological and functional results with minimal loss of reduction.