Fixation of dorsal rim fragments in distal radial intra-articular fractures: Is it necessary

Abstract

Background To retrospectively analyze the effects of open reduction and internal fixation (ORIF) of AO type C intra-articular fractures on the recovery of wrist function in distal radial fractures with or without dorsal rim fragments and with or without dorsal rim fragment fixation. Methods A total of 98 patients with type C distal radius fractures treated with ORIF using the volar approach were enrolled. They were divided into three groups based on the existence and fixation of dorsal rim fragments: no dorsal rim fragment, fixed dorsal rim fragment, and unfixed dorsal rim fragment. Patients were followed-up with radiographs, range of motion (ROM), disabilities of arm, shoulder, and hand (DASH) scores, and Gartland–Werley (G–W) scores. Results The radiographs showed significant improvement at each follow-up time point compared to the preoperative status in all groups. There were no significant differences in the G–W and DASH scores among the three groups, except for the DASH score 3 months after surgery. No significant differences in wrist ROM, functional assessment scores, volar tilt angle, or radial length were observed between the fixed and nonfixed groups. Conclusion ORIF with locking plates is an effective approach for restoring the wrist anatomy in AO type C distal radius fractures. Significant differences were observed in radial inclination, radial styloid height, and postoperative wrist flexion ROM between the three groups 12 months after surgery, whereas no significant differences were found in volar tilt angle, other wrist ROMs, G–W, or DASH scores. Therefore, fixing dorsal rim fragments in distal radial intra-articular fractures is unnecessary.