Combined Volar T-Plate and Dorsal Pi-Plate for Distal Radius Fractures: A Consecutive Series of 80 AO type C2 and C3 Cases

Abstract

Background The distal radius fracture (DRF) is the most common fracture among adults. In recent years, there has been a shift toward volar locking plates in the treatment of DRFs, and this shift has taken place with a low degree of evidence. Question/purposes Can combined volar T-plating and dorsal pi-plating of AO type C fractures yield a good functional and radiographic outcome 1 year postoperatively? Patients and Methods In a retrospective cohort study, we evaluated 102 consecutive patients operated with combined dorsal and volar plating, of whom 80 completed the 1-year follow-up. The DRFs were operated between 2012 and 2013. All cases were AO type C2 and C3 fractures. The primary outcome was functional scoring including radiographic examination. Secondary outcome measures included range of motion, visual analog scale (VAS) pain scores, and hand grip strength. Results The median Batra radiographic score was 84.5. Wrist extension was 74% of the uninjured side, flexion was 70%, pronation was 94%, and supination was 90%. The Patient-Rated Wrist Evaluation score was 21 points, and the Disabilities of the Arm, Shoulder, and Hand score was 19.4 points. VAS pain scores were 0 at rest and 3 during activity. Hand grip strength was 80% of the uninjured side. Radiographic outcome did not correspond to a patient-reported outcome. Hardware removal was performed in 15/80 cases. Conclusions We conclude that a good outcome can be expected after combined dorsal and volar plating of DRFs. Radiographic outcome is not necessarily associated with functional outcome 1 year postoperatively. The rate of hardware removal was acceptable. Level of Evidence III

Combined Plating of Intra-Articular Distal Radius Fractures, a Consecutive Series of 74 Cases

“…These findings are better compared with the findings in other studies on combined plating. 14,15,24,25 Landgren et al reported a wrist flexion of 65 degrees and extension of 63 degrees in a randomized controlled study in a group of AO type A and C fractures treated with fragment-specific fixation with similar results for another group treated with volar locking plates which is better than the flexion and extension in this study. 26 This could indicate that wrist extension may be negatively affected by the dorsal exposure in combined plating, compared with the more limited dorsal approach in fragment-specific fixation.…”

“…The grip strength was 82% compared with the uninjured side which is lower than in Landgren's study on fragmentspecific fixation and volar locking plates but better than the grip strength found in other studies on combined plating. 14,15,25 The PRWE score in our study was somewhat lower, indicating a better outcome than what was reported in another study on combined plating with a similar cohort of patients. 15 The QuickDASH-score in our study was higher, indicating an inferior outcome, compared with the DASHscore reported by Landgren.…”

“…14,15,25 The PRWE score in our study was somewhat lower, indicating a better outcome than what was reported in another study on combined plating with a similar cohort of patients. 15 The QuickDASH-score in our study was higher, indicating an inferior outcome, compared with the DASHscore reported by Landgren. 26 However, their study group of patients also included AO type A fractures in comparison to our material of only type C fractures.…”

“…Combined plating using the pi-plate has previously demonstrated a good outcome in the treatment of complex DRFs. 14,15,23,24 However, the pi-plate has been discontinued by the manufacturer. The dorsal frame plate is a modern plate with a smooth low-profile surface sharing some similarities with the pi-plate.…”

“…12 Good results have been reported for combined volar and dorsal plate fixation of complex intra-articular DRFs using the pi-plate system; however, this implant has been discontinued by the manufacturer. [13][14][15] Reports on combined volar and dorsal plating of complex intra-articular fractures using modern implants are scarce. In addition, some studies indicate that for older patients with a DRF, the functional outcome is the similar regardless type of treatment.…”