A representative case of osteoporotic distal radius fracture

We present a case with nonsimultaneous bilateral dorsally displaced unstable osteoporotic distal radius fractures treated by open reduction and internal fixation using a volar and dorsal locking-plate system in a 69-year-old man. On the left side the patient had a loss of reduction as a result of plate bending 1 week after palmar plating. Correction of the dorsopalmar tilt was achieved through additional dorsal plating. Three months later the same patient sustained a distal radius fracture on his right forearm. Open anatomic reduction could only be achieved using palmar and dorsal locking plates, and the large metaphyseal defect was filled with resorbable bone substitute. Six weeks after surgery the patient reported persisting wrist pain. The x-rays showed loss of reduction. Because of flexor tendon irritation, the plate had to be removed after healing malunited. At the final follow-up at 18 months, the patient showed good subjective results according to the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire results. Active wrist motion was 60 degrees extension on the left and 55 degrees extension on the right. The active range of flexion was 50 degrees for left and right wrist, and active pronation and supination were unrestricted for both forearms. Grip strength was 50 kg on either side. Although recently good and excellent results have been reported treating distal radius fractures using volar locking plates in elderly individuals, we believe these implants still have their limits depending on local bone quality and fracture pattern. Decisionmaking for surgery versus conservative treatment should balance the risks and advantages for each patient accurately.