A Randomised Clinical Study Comparing Palmar and Dorsal Fixed-Angle Plates for the Internal Fixation of AO C-Type Fractures of the Distal Radius in the Elderly

Abstract

Current surgical treatments for distal radial fractures include dorsal and palmar plate fixation. We report results of a randomised study comparing these methods for AO C1-3 fractures. The emphasis was placed on the early postoperative functional recovery within the first 6 months as this interval is of decisive importance for elderly patients. Thirty patients with unilateral AO C1-3 fractures were enroled, 15 were treated with a palmar plate and 15 received a dorsal Pi-plate. Results were assessed 6 weeks, 3 months and 6 months postoperatively focusing on functional recovery. The palmar plate group demonstrated significantly better results in range of motion, grip strength and pain.

Dorsal and Volar 2.4-mm Titanium Locking Plate Fixation for AO Type C3 Dorsally Comminuted Distal Radius Fractures

“…[3][4][5]18 However, the direct dorsal approach should not be totally excluded because it indeed provides surgeons with a good opportunity to directly restore the disrupted dorsal cortical rim and realign the rotated dorsal cortical fragments that cannot be reduced indirectly. 14,15 Because of the low-profile design and multiple available shapes of this dorsal-plating system, the 2.4-mm titanium dorsal locking plate can be easily applied without apparent tendon irritation; furthermore, a column-specialized fixation can be achieved by using a dorsal locking plate on the medial column and a dorsoradial plate or styloid plate on the radial column. 19,20 The dorsal and volar plates are mainly used in cases of dorsal rim comminution and metaphyseal comminution, respectively; thus, the 2 groups in this study were not identical and are therefore not entirely comparable.…”

Is an implant removal after dorsal plating of distal radius fracture always needed?

“…Moreover, there is a close relation between the extensor tendons and dorsally placed implant. In current literature, published complications rates in dorsal radius plating are as high as 60 % (19,27,28).…”

The operative treatment of fractures of the distal radius is increasing

“…6 The angle-stable screws gave more secure fixation, even in severely osteoporotic bone, 7,8 and the volar position of the plate proved to give rise to fewer complications from impingement by tendons. 5,9 The risk of complications after volar plating in terms of tendon rupture, hardware problems and nerve compression is reported to be approximately 10%, 10 and between 15% and 34% of patients have their hardware removed within a year. [11][12] Published studies that compare the clinical outcomes of volar plating and external fixation have shown that those treated with a volar plate return to normal function more quickly but the long-term outcome is equal after both treatments.…”