title: Combined dorsal and volar plate fixation of complex fractures of the distal part of the radius.
abstract: BACKGROUND
  Fractures of the distal part of the radius that are associated with complex comminution of both the articular surface and the metaphysis (subgroup C3.2 according to the Comprehensive Classification of Fractures) are a challenge for surgeons using standard operative techniques.
  
  
  METHODS
  Twenty-five patients with subgroup-C3.2 fractures that had been treated with combined dorsal and volar plate fixation were evaluated at an average of twenty-six months after the injury. Subsequent procedures included implant removal in twenty-one patients and reconstruction of a ruptured tendon in two patients.
  
  
  RESULTS
  An average of 54 degrees of extension, 51 degrees of flexion, 79 degrees of pronation, and 74 degrees of supination were achieved. The grip strength in the involved limb was an average of 78% of that in the contralateral limb. The average radiographic measurements were 2 degrees of dorsal angulation, 21 degrees of ulnar inclination, 0.8 mm of positive ulnar variance, and 0.7 mm of articular incongruity. Seven patients had radiographic signs of arthrosis during the follow-up period. A good or excellent functional result was achieved for twenty-four patients (96%) according to the rating system of Gartland and Werley and for ten patients (40%) according to the more stringent modified system of Green and O'Brien.
  
  
  CONCLUSIONS
  Combined dorsal and volar plate fixation of the distal part of the radius can achieve a stable, mobile wrist in patients with very complex fractures. The results are limited by the severity of the injury and may deteriorate with longer follow-up. A second operation for implant removal is common, and there is a small risk of tendon-related complications.
authors.affiliation: Department of Orthopaedic Surgery, Massachusetts General Hospital, Yawkee Center, Suite 2100, 55 Fruit Street, Boston, MA 02114, USA. dring@partners.org
authors.forename: David
authors.initials: D
authors.lastname: Ring
authors.forename: Karl
authors.initials: K
authors.lastname: Prommersberger
authors.forename: Jesse B
authors.initials: JB
authors.lastname: Jupiter
mesh_terms: D001860:Bone Plates; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods*; D018460:Fractures, Comminuted / Q000601:surgery*; D006801:Humans; D011885:Radius Fractures / Q000601:surgery*; D016059:Range of Motion, Articular