“Sandwich” Plating for Intra-articular Distal Radius Fractures with Volar and Dorsal Metaphyseal Comminution

Abstract

Introduction Intra-articular distal radius fractures with volar and dorsal comminution present a special challenge to the hand surgeon. Methods Ten patients formed the study cohort. All plates were low profile and stainless steel. Radiographic parameters, range of motion, and strength compared to the uninjured side were recorded. Functional outcome was evaluated by Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and Gartland and Werley scoring system. Results Median age at surgery was 58 years (range, 24 to 86). Mean follow-up was 17 months (range, 12 to 28). According to the AO classification system, there were three type C2 and seven type C3 fractures. Median preoperative dorsal angulation was 24 deg; median postoperative dorsal angulation was 3 deg. Eighty percent (8) of the fractures also had an intra-articular step-off or gap, all of which were corrected to neutral by the procedure. Compared with the contralateral side, mean extension and flexion were 73 and 75%, respectively, pronation and supination were 95 and 88%, respectively, and grip strength and thumb pinch were 72 and 87%, respectively. Mean postoperative DASH score was 16 points, and 70% (7) of the patients had Gartland and Werley scores of good or excellent. None of the patients needed to have their plates removed, and no extensor tendon rupture was reported. Conclusions The "sandwich" plating technique is an effective method of regaining near-anatomic reconstruction of intra-articular, volarly and dorsally comminuted distal radius fractures. Results from this study demonstrate that patients can expect to regain about 80% of their range of motion and strength. Moreover, 70% of the patients will have good to excellent functional outcomes. This is the first study to examine range of motion and functional outcome of low-profile "sandwich" plating without plate removal.

Ligamentotaxis versus Open Reduction and Internal Fixation for Distal Radius Intra-Articular Fractures

“…Day et al [20] reported the results of 12 patients who were treated by double plating, whose functional outcome were evaluated by DASH questionnaire and Gartland and Werley scoring system. They reported that 70% of the patients had good or excellent outcome.…”

External Fixator for Maintaining Reduction Before Volar Plating

“…3,4,18 Dicpinigaitis et al 19 found that loss of reduction of volar tilt was observed for up to 6 months after EF, despite the use of pinning to secure the reduction. Various methods are available for treating these complex fractures.…”

Outcome following Distally Locked Volar Plating for Distal Radius Fractures with Metadiaphyseal Involvement

“…They had similar results with one reported tendon rupture and one broken plate. Mudgal and Ring reported utilizing a T-plate and a DC plate secured together to allow adequate fixation of the distal fragment to the radial shaft [13], and Day et al described dorsal and volar sandwich plating [3]. While these techniques allow for better bony fixation, bridge plating mandates a second surgery for hardware removal to allow motion.…”

“…While previous volar, distal radial plates have had the ability to adequately control both intra-articular and/or juxta-articular fracture fragments [15, 17], their shaft length was not adequate to control both the articular surface and span extensive metadiaphyseal comminution while accommodating a typical radial bow. Other techniques, such as stacked plating [3, 13] and bridge plating [1, 6, 7, 18] have been recently described in an attempt to treat these difficult fractures; however, these techniques may utilize multiple plates and, at times, necessitate a secondary surgery for hardware removal [1, 6, 7, 18].…”