Open Reduction and Internal Fixation of Intra Articular and Unstable Fractures of the Distal Radius Using the AO Distal Radius Plate

Abstract

This study reports the results of open reduction and internal fixation of 25 dorsally displaced distal radial fractures using a specifically designed plate for the distal radius, the AO pi plate (Synthes Ltd, Paoli, USA). Twenty-one of these fractures were complex and intra-articular (AO Type 'C'). Measurement of range of motion of the affected wrist at an average follow-up of 16 months revealed a median return of 60 degrees of wrist extension, 40 degrees of wrist flexion, 90 degrees of pronation and 90 degrees of supination. Radiographic assessment revealed restoration of normal radial length, inclination and palmar tilt in all but six cases. The final outcome, as assessed by the Gartland and Werley scale, was excellent in four cases, good in 11, and fair in ten cases. Complications were seen in five patients.

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

“…Tenosynovitis and extensor tendons ruptures had received an extensive attention in recent papers (25,29,30,31). Tendinitis resulting in need for plate removal had been reported in up to 20 % to 33 % of cases (17,25). To prevent this complication, some authors suggested an early implant removal (22,23).…”

“…Although meta-analysis has failed to show superiority of specifi c operative treatment method (15), Jupiter (3,16) and other researchers (5,17,18) acknowledged that open reduction and internal fi xation with plates has obvious advantages over the other methods of distal radius fracture fi xation. It allows a direct restoration of anatomy, stable internal fi xation, shorter immobilization period, and thus an earlier return of wrist function.…”

Clinical profile of patients with unstable distal radius fracture

“…We observed these injuries to be occurring more commonly in males in their early middle age of 40s. [7,8] In our study operative group 11 (61%) out of 18 cases had fracture styloid process of ulna, 2 male cases had fracture tibial plateu, 2 male & 2 female cases had fracture shaft of humerus, 2 male cases had fracture leg bone & 2 cases (one male & one female) fracture shaft of femur. Most of the cases were of ipsilateral side.…”

Volar locking plate fixation for distal radius fractures: Does age affect outcome?

“…23 For unstable distal radial fractures, closed reduction has been reported to compromise functional return and result in malunion in up to 50%. 24,21,25 Treatment options include percutaneous wiring, reported as ineffective in osteoporotic bone, 26,27 dorsal plate fixation, which can lead to attrition ruptures of extensor tendons, 28 and external fixation, which carries the risk of pin tract infection and wrist stiffness. 29 One option for treating these complex fractures is by open reduction and internal fixation.…”