Dorsal Plate Fixation for Dorsally Displaced Distal Radius Fractures

Ki-Tae Na; Seok-Whan Song; Yoon-Min Lee; Byung-Min Kang

doi:10.12790/jkssh.2014.19.1.44

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Na, Song, Lee, and Kang: Dorsal Plate Fixation for Dorsally Displaced Distal Radius Fractures

ORIGINAL ARTICLE

J Korean Soc Surg Hand 2014;19(1):44-51.

Published online: 11 March 2014

DOI: https://doi.org/10.12790/jkssh.2014.19.1.44

Dorsal Plate Fixation for Dorsally Displaced Distal Radius Fractures

Ki-Tae Na, Seok-Whan Song, Yoon-Min Lee, Byung-Min Kang

Department of Orthopedic Surgery, Yeouido St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea

Correspondence to: Seok-Whan Song, Department of Orthopedic Surgery, Yeouido St. Mary's Hospital, The Catholic University of Korea College of Medicine, 10 63(yuksam)-ro, Yeongdeungpo-gu, Seoul 150-713, Korea, TEL: +82-2-3779-1192, FAX: +82-2-783-0252, E-mail: sw.song@catholic.ac.kr

Received 4 February 201410 March 2014 Accepted 11 March 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose:

The object of this study is to evaluate the clinical and radiographic outcomes of two different kinds of dorsal plating for dorsally displaced distal radius fractures.

Methods:

Forty-three patients with dorsal plate fixation for distal radius fracture were retrospectively reviewed. Twenty-four patients were treated with nonlocking dorsal plate (group I) and nineteen patients with locking dorsal plate (group II). Range of motion and Green and O'Brien score were evaluated as clinical results, and radial inclination, radial length, volar tilt at postoperative and last follow up were evaluated as radiographic results.

Results:

According to AO classification system, there were 18 type A fractures, 4 type B fractures, 21 type C fractures. In group I, the mean flexion and extension were 65.0° and 65.3°, respectively; ulnar and radial deviation were 25.5° and 20.8°; pronation and supination were 80.0° and 80.4°. In group II, the mean flexion and extension were 64.5° and 67.3°, respectively; ulnar and radial deviation were 30.6° and 20.6°; pronation and supination were 81.4° and 78.6°. The mean Green and O'Brien score was 94.4 in group I and 92.2 in group II, and 41 patients had satisfactory result. There was no statistical significant difference in clinical results between the groups. Results of postoperative and last follow-up radiographic analyses for mean radial inclination were 23.9° and 24.1° in group I, respectively, and 24.2° and 24.9° in group II; radial length were 9.9 mm and 9.7 mm in group I, and 10.1 mm and 9.2 mm in group II; mean volar tilt were 12.2° and 13.1° in group I, and 14.8° and 13.7° in group II. There were no statistical significant changes within radiographic parameters. No extensor tendon rupture was reported.

Conclusion:

Dorsal plate fixation for dorsally displaced distal radius fracture showed satisfactory clinical and radiographic outcomes with low complication rate, regardless of the type of plate.

Keywords: Distal radius, Fracture, Dorsal plate

References

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Fig. 1.

Dorsal approach for distal radius fracture. (A) Skin incision over Lister's tubercle with zigzag pattern at dorsal aspect of wrist joint. (B) Subperiosteal elevation after dissection of extensor retinaculum. (C) Dorsal plate fixation after the reduction of fracture site and temporary fixation with K-wires. (D) Proximal half of extensor retinaculum was used to cover plate and distal screws. (E) Distal half of extensor retinaculum was repaired. (F) Extensor pollicis longus tendon was placed as subcutaneous.

Fig. 2.

Sixty-eight-year-old male, with dorsally displaced unstable distal radius fracture, was treated with open reduction and internal fixation using dorsal locking T-plate. (A) Preoperative radiographs show AO A3 type distal radius fracture. (B) Postoperative radiographs show good reduction and fixation. (C) Twelve months later, radiographs show no interval change.

Table 1.

Range of motion

Type of motion	Total	Group I	Group II	p-value
Flexion (°)	65.8 (25–90)	65.0 (25–90)	64.5 (40–90)	0.958^*
Extension (°)	66.2 (30–90)	65.3 (30–90(	67.3 (30–90)	0.825^*
Ulnar deviation (°)	27.4 (0–45)	25.5 (0–35)	30.6 (15–45)	0.515^*
Radial deviation (°)	20.7 (5–40)	20.8 (5–40)	20.6 (5–35)	1.0^*
Pronation (°)	80.7 (40–90)	80.0 (40–90)	81.4 (50–90)	0.837^*
Supination (°)	79.3 (40–90)	80.4 (40–90)	78.6 (40–90)	0.650^*

Values are presented as mean (range).

^* Independent t-test (between group I and group II).

Table 2.

Functional outcomes

Green and O'Brien score	Total	Group I	Group II	p-value
Pain (0-25)	21.5 (15–25)	20.8 (15–25)	22.3 (15–25	-
Range of motion (5-25)	21.4 (10–25)	21.4 (10–25)	21.4 (15–25)	-
Occupation (0–25)	19.7 (5–25)	21.1 (15–25)	17.7 (5–25)	-
Grip power (0–10)	6.8 (5–10)	6.7 (5–10)	6.9 (5–10	-
X-ray (0–25)	24.3 (20–25)	24.4 (20–25)	24.1 (20–25)	-
Total	94.0 (70–110)	94.4 (70-110)	92.2 (75–110)	0.659^*

Values are presented as mean (range).

^* Independent t-test (between group 1 and group 2).

Table 3.

Changes in radiographic parameters

	Radial inclination (°)	Radial length (mm)	Volar tilt (°)
Total
Postoperative	24.0±4.22	10.0±2.44	13.2±8.2
Latest follow-up	24.4±4.04	9.5±3.0	13.3±7.7
p-value	0.523^*	0.091^*	0.930^*
Group I
Postoperative	23.9±4.50	±	12.2±8.47
Latest follow-up	24.1 ±4.70	±	13.1±7.63
p-value	0.801^*	0.528^*	0.248^*
Group II
Postoperative	24.2±3.97	10.1±2.45	14.8±7.89
Latest follow-up	24.9±2.90	9.2±1.70	13.7±8.15
p-value	0.479^*	0.084^*	0.844^†

^* Paired t-test;

^† Wilcoxon signed ranks test.

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