Volar versus combined dorsal and volar plate fixation of complex intraarticular distal radius fractures with small dorsoulnar fragment – a biomechanical study

Abstract

Complex intraarticular distal radius fractures (DRFs), commonly managed with volar locking plates, are challenging. Combined volar and dorsal plating is frequently applied for treatment, however, biomechanical investigations are scant. The aim of this biomechanical study was to investigate volar plating versus double plating in DRFs with different degrees of lunate facet comminution.Thirty artificial radii with simulated AO/OTA 23-C2.1 and C3.1 DRFs, including dorsal defect and lunate facet comminution, were assigned to 3 groups: Group 1 with two equally-sized lunate facet fragments; Group 2 with small dorsal and large volar fragment; Group 3 with three equally-sized fragments. The specimens underwent volar and double locked plating and non-destructive ramped loading in 0° neutral position, 40° flexion and 40° extension.In each tested position, stiffness: (1) did not significantly differ among groups with same fixation method (p ≥ 0.15); (2) increased significantly after supplemental dorsal plating in Group 2 and Group 3 (p ≤ 0.02).Interfragmentary displacements between styloid process and lunate facet in neutral position were below 0.5 mm, being not significantly different among groups and plating techniques (p ≥ 0.63).Following volar plating, angular displacement of the lunate facet to radius shaft was significantly lower in Group 1 versus both Group 2 and Group 3 (p < 0.01). It decreased significantly after supplemental dorsal plating in Group 2 and Group 3 (p < 0.01), but not in Group 1 (p ≥ 0.13), and did not differ significantly among the three groups after double plating (p ≥ 0.74).Comminution of the lunate facet within its dorsal third significantly affected the biomechanical outcomes related to complex intraarticular DRFs treated with volar and double locked plates.Double plating demonstrates superior stability versus volar plating only for lunate facet comminution within its dorsal third. In contrast, volar plating could achieve stability comparable with double plating when the dorsal third of the lunate facet is not separated by the fracture pattern. Both fixation methods indicated achievable absolute stability between the articular fragments.

Biomechanical comparison of radiopalmar double plating with conventional palmar plating in comminuted distal radius fractures

“…Berglund and Messer described three typical types of loss of reduction in extension fractures of the distal radius: dorsi exion, loss of radial length and loss of reduction of the lunate facet [15]. Particularly in cases with pronounced defect zones or osteoporotic bone, various authors have investigated different options for support, using screw augmentation or combined osteosynthesis [9,[16][17][18][19]. Some of these biomechanical studies showed superiority of the stability of combined dorsopalmar plate osteosynthesis in complex distal radius fractures.…”

Volar Locking Plate Compared With Combined Plating of AO Type C Distal Radius Fractures: A Randomized Controlled Study of 150 Cases

“…14 Combined plating can provide direct visualization of the DUC, which can facilitate reduction and stabilization of the DUC fragment and provide sufficient stability for early mobilization and good functional and radiographic outcomes in complex fractures. [15][16][17][18][31][32][33] The drawbacks of using combined plating include prolonged duration of surgery, more extensive soft tissue dissection, and tendon irritation from the dorsal plate. The introduction of low-profile plates has reduced this problem.…”

“…14 In these cases, volar plating can be combined with dorsal plate fixation (combined plating) as an option for reduction. 15 Combined plating has shown good outcomes and anatomical restoration but high frequencies of hardware removal and tendon ruptures. 16e19 There are several studies comparing volar locking plate fixation with closed reduction for DRFs, but these studies were generally based on data including different AO types.…”

Management of complex wrist fractures with volar and dorsal locked (double-locked) K-lock

“…A thought process then developed around the possible enhancement in construct strength by double locking the K-lock wire (volar and dorsal plates), for severely comminuted fractures for adequate reduction and rigid fixation. [2][3][4]9 All patients were operated on using the Newclip Xpert Wrist 2.4 set and Klock ( Fig. 4).…”

“…1 In severely comminuted fractures with dorsal fragments, especially in the intermediate column, a dual approach may be required with both volar and dorsal fixation. [2][3][4] These fracture patterns usually include a free dorsal lunate fossa fragment, and stabilizing this column is essential to the maintenance of radial length and congruency of the joint. 5 These fractures also often involve the sigmoid fossa of the distal radioulnar joint.…”