12-month follow-up of 205 intraarticular distal radius fractures operated with a dorsal pi-plate and a volar T-plate

Background

Recent studies have found postoperative complications including malalignment of the fracture and rupture of both the flexor and extensor tendons with volar approach for distal radius fracture.
Previous studies with dorsal and volar technique are few and the number of patients studied is also small. We report the results of 205 cases performed at the University Hospital, Örebro during 2005.

 

Material and Methods

A consecutive series of 205 patients (mean age 50 years) was studied.
Physiotherapy was initiated after 2 weeks in plaster. An physiotherapist
followed up all the patients after 1, 6, and 12 months and X-ray of the wrist was done 1 and 12 months after surgery.

Results

The most common mechanism of trauma was a fall, with only a minority of all C2 and C3 fractures having had a high-energy-trauma. Clinical follow-up showed good ROM and strength.
AO staging showed a distribution of 4 B2, 17 C1, 44 C2 and 140 C3 fractures.
The Batra-staging showed 72% excellent results, 15% good, 10% fair and 3% poor after 1 year.
VAS-score after 6 months was 1.1 and VAS-score after 12 month was 0.23 (p<0,001).

Complications

One deep infection that resulted in an early removal of the plates, and one radio-carpal arthrodes.
In 3 patients there was a collapse of the distal radius (all extraarticular metaphyseal) after plate removal which was treated with a correctional osteotomy.
1 EPL-rupture, 1 FPL-rupture
1 patient with numbness in the Median nerve-innervated area.
1 patient with numbness in the thumb and 1 in the digit III.
Removal of the volar and dorsal plates was performed in 55 patients (45%

Discussion

We found clinical and radiographically excellent results after double-plating osteosynthesis for communitive intra-articular distal radius fractures.
The perpendicular radial and ulnar distal arm of the pi-plate allows an exact and steady reduction with a low risk for late compression of the fracture.
The advantage of a stable and anatomical exact reduction is crucial for good long- term results for communitive intra-articular distal radius fractures