Volar spanning plate fixation for a distal radius fracture

Abstract

A comminuted distal radial fracture is sometimes so fragmented that it is impossible to treat it with fixation using a plate and screws. In this case, we can perform a bridging fracture and joints with an external fixator or a dorsal spanning plate. Unfortunately, both methods completely immobilize the wrist until the implants are removed. In the article is presented an alternative method of bridge fixation. After fracture bridging with a volar spanning plate, the patient immediately has the possibility of dorsal and volar flexion of approximately 30 degrees in each direction. The study group consists of 6 patients treated surgically with a volar spanning plate after an unsuccessful attempt of stable fixation with a volar plate. 5 patients suffered from a distal radius fracture in the AO classification type C3, and one man with an inveterate dorsal dislocation of the wrist and fracture of the radial styloid process type B1. The volar spanning plate was fixed distally in the scaphoid and lunar, and proximally in the shaft of the radius. All patients achieved bone union. There was no destabilization or any damage of the implant. The average dorsal flexion was 48°, and the palmar flexion was 45°. All patients obtained a satisfactory result according to the Mayo scale, without pain. The volar spanning plate may be indicated when intraoperative fixation by a volar plate turns out to be too optimistic. Compared to the external fixator or the dorsal spanning plate, the volar spanning plate does not distract the midcarpal and carpometacarpal joints. What is more, immediately after the operation, the possibility of dorsal and palmar flexion are approximately 30 degrees in each direction, which improves the quality of life in the first weeks of treatment. After removing the implant, there is still a chance to improve the range of motion of the wrist.