Volar collapse after dorsal plating of comminuted distal radius fractures

Between 1997 and 2001, 58 patients received dorsal plating for comminuted distal radius fractures. In 8 of these patients, subsequent collapse led to palmar flexion deformity, loss of rotation, and hardware prominence. In retrospectively reviewing this subgroup's range of motion, radiographic volar tilt, and complications, including tenosynovitis and extensor tendon rupture, we found that (1) with both palmar and dorsal comminution of distal radius fractures, dorsal plating may not prevent palmar cortex collapse; (2) deformity of the distal radius fragment causes palmar displacement of the radius relative to the intact ulna; (3) resultant incongruity at the distal radioulnar joint causes a significant loss of supination; and (4) palmar distal radius displacement leads to dorsal hardware prominence and may contribute to tenosynovitis and attritional extensor tendon ruptures.