Adjunctive dorsal spanning plate fixation for challenging distal radius injuries

Clarke Cady-McCrea; James D Brodell Jr; Thomas J Carroll; Urvi Patel; Akhil Dondapati; Sandeep Soin; John Ketz

doi:10.1016/j.jor.2024.03.003

Adjunctive dorsal spanning plate fixation for challenging distal radius injuries

J Orthop. 2024 Mar 8:54:5-9. doi: 10.1016/j.jor.2024.03.003. eCollection 2024 Aug.

Authors

Clarke Cady-McCrea¹, James D Brodell Jr¹, Thomas J Carroll¹, Urvi Patel¹, Akhil Dondapati¹, Sandeep Soin¹, John Ketz¹

Affiliation

¹ University of Rochester Department of Orthopaedic Surgery, University of Rochester School, Rochester, NY, USA.

PMID: 38516390
PMCID: PMC10950736 (available on 2025-08-01)
DOI: 10.1016/j.jor.2024.03.003

Abstract

Background: Distal radius fractures with severely osteoporotic bone or articular comminution can provide challenges to fixation with traditional volar locked plating alone. The purpose of this study was to evaluate the clinical, radiographic, and patient reported outcomes of patients undergoing distal radius fixation with volar locked plating and adjunctive dorsal bridge plating.

Methods: We retrospectively identified 16 patients with distal radius fractures who underwent our preferred surgical technique for fixation. Patients underwent volar locked plate fixation as well as dorsal bridge fixation at time of surgery. Seven patients were indicated for severe articular comminution with volar rim fragmentation (44%), three patients were revised for nonunion after previous volar locked late fixation (19%), and six patients had severely osteoporotic bone with articular comminution (38%). Two patients (13%) sustained AO/OTA 23-A3 distal radius fracture, two patients (13%) had a 23-B3 fracture, two patients (13%) had a 23-C2 fracture and ten patients (63%) had a 23-C3 fracture.

Results: The average patient age was 51.8 years ± 20.6. Patients were followed for an average of 12.2±6.3 months. The dorsal bridge plate was removed at an average of 11.1±2.4 weeks. The average post-operative radial inclination was 18.9±2.4°, radial height 12.4 mm ± 2.6 mm, and volar tilt 7.1±1.9°. There were no cases of deep or superficial infection. After dorsal bridge plate removal, patients demonstrated an average wrist extension of 55.3±9.5°, flexion 54.4±12.8°, radial deviation 15.7±3.2°, 25.2±3.9 degrees of ulnar deviation.

Conclusion: Distal radius fractures in the setting of severely osteoporotic bone, salvage procedures, articular comminution, volar rim fractures, and revision surgery present uniquely difficult surgical challenges. Volar locked plating with adjunctive dorsal bridge plating can be used with good short- and long-term results.

Keywords: Bridge plate; Colles fracture; Distal radius; Dual plate fixation; Volar plate.