Radiographic Outcomes for Comminuted, Intra-articular Distal Radius Fractures Treated with Primary Distraction Bridge Plate Fixation.

Indian J Orthop

Department of Orthopaedic Surgery, Division of Hand and Microvascular Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 USA.

Published: April 2023

Purpose: To determine if distraction bridge plate (DBP) fixation as the primary method of stabilization can effectively correct and maintain acceptable radiographic parameters in the treatment of comminuted, intra-articular distal radius fractures while allowing early load-bearing.

Methods: A retrospective review was performed of all consecutive intra-articular distal radius fractures that underwent DBP fixation with or without supplemental fixation methods (fragment-specific implants or K-wires). Patients treated with a volar locked plate in addition to DBP were excluded. Radiographic outcomes measures included volar tilt (°), radial height (mm), radial inclination (°), articular step-off (mm), lunate-lunate facet ratio (LLFR), and teardrop angle (°) measured on post-reduction, immediately post-operative, prior to and after DBP removal.

Results: Twenty-three comminuted, intra-articular distal radius fractures were treated with primary DBP fixation. Supplemental fixation was utilized in 10 fractures and included fragment-specific implants ( = 6) and/or K-wires ( = 5). Distraction bridge plates were removed after a mean of 13.6 weeks. At a mean radiographic follow-up of 11.4 weeks (range: 2-45 weeks) following DBP removal, all fractures had united with a mean volar tilt of 6.3° ± 5.8°, radial height of 11.3 ± 2.3 mm, radial inclination of 20.2° ± 4.5°, articular step-off of 0.6 mm ± 0.8, and LLFR of 1.05 ± 0.06. However, the teardrop angle could not be restored to a normal value with DBP fixation. Complications included 1 plate breakage and 1 peri-hardware radial shaft fracture.

Conclusion: Distraction bridge plate fixation is a reliable method to stabilize highly comminuted, intra-articular distal radius fractures in patients with a well-aligned volar rim fragment of the lunate facet.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10050499PMC
http://dx.doi.org/10.1007/s43465-022-00812-3DOI Listing

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