Treatment of distal radius fractures with a low-profile dorsal plating system: an outcomes assessment.
OBJECTIVE
To evaluate objective functional and radiographic outcomes after internal fixation of acute, displaced, and unstable fractures of the distal aspect of the radius in adults by using a low-profile dorsal plating system. Our hypothesis was that the low-profile dorsal plating system would allow for a reduction of extensor tendon irritation and pain and provide stable osseous fixation.


METHODS
Sixty consecutive unstable fractures in 59 patients were treated by open reduction internal fixation using a low-profile dorsal plating system. There were 29 type A, 14 type B, and 8 type C fractures (AO classification system). Fifty patients with 51 fractures returned for outcomes assessment by physical examination, plain radiographs, and completion of a validated musculoskeletal function assessment questionnaire. The minimum follow-up period was 1 year; the mean follow-up period was 24 months. Clinical evaluation was performed and plain radiographs were assessed for maintenance of immediate postoperative reduction and implant position. Objective functional assessment was obtained through the Disabilities of the Arm, Shoulder, and Hand questionnaire.


RESULTS
Outcomes analysis showed no cases of extensor tendon irritation or rupture. Hardware removal was performed in 1 patient but no extensor tendon irritation or rupture was evidenced. The mean Disabilities of the Arm, Shoulder, and Hand score was 11.9; implant-related discomfort was minimal. All patients had an excellent (31 patients) or good (19 patients) result according to the scoring system of Gartland and Werley. The mean active range of motion was greater than 80% of that of the contralateral wrist in flexion/extension, pronation/supination, and ulnar/radial deviation. Extensor tendon function was unimpaired in all patients. Grip and pinch strength averaged 90% and 94% of the contralateral sides, respectively. Radiographic evaluation showed no change in fracture reduction or implant position.


CONCLUSIONS
The treatment of distal radius fractures with a low-profile stainless steel dorsal plating system is a safe and effective method that provides stable internal fixation and allows for full extensor tendon glide and full metacarpophalangeal joint motion. Objective outcome testing showed uniformly good to excellent recovery of wrist and hand function in all patients.


METHODS
Therapeutic, Level IV.
Simic
Paul M
PM
Southern California Orthopaedic Institute, Van Nuys, CA, USA.
Robison
Jason
J
Gardner
Michael J
MJ
Gelberman
Richard H
RH
Weiland
Andrew J
AJ
Boyer
Martin I
MI
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001860:Bone Plates; D015331:Cohort Studies; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000295:instrumentation* / Q000379:methods; D018737:Hand Strength / Q000502:physiology; D006801:Humans; D007593:Joint Instability / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011403:Pronation / Q000502:physiology; D011474:Prosthesis Design; D011859:Radiography; D011885:Radius Fractures / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D016059:Range of Motion, Articular / Q000502:physiology; D012189:Retrospective Studies; D013484:Supination / Q000502:physiology; D014955:Wrist Joint / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery