“Sandwich” Plating for Intra-articular Distal Radius Fractures with Volar and Dorsal Metaphyseal Comminution |
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Authors: | Charles S Day Atul F Kamath Eric Makhni Jerome Jean-Gilles David Zurakowski |
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Institution: | (1) Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA;(2) Department of Orthopaedic Surgery, Children’s Hospital Boston, 300 Longwood Avenue, Hunnewell 218, Boston, MA 02115, USA |
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Abstract: | Introduction Intra-articular distal radius fractures with volar and dorsal comminution present a special challenge to the hand surgeon.
Methods Ten patients formed the study cohort. All plates were low profile and stainless steel. Radiographic parameters, range of motion,
and strength compared to the uninjured side were recorded. Functional outcome was evaluated by Disabilities of the Arm, Shoulder
and Hand (DASH) questionnaire and Gartland and Werley scoring system.
Results Median age at surgery was 58 years (range, 24 to 86). Mean follow-up was 17 months (range, 12 to 28). According to the AO
classification system, there were three type C2 and seven type C3 fractures. Median preoperative dorsal angulation was 24 deg;
median postoperative dorsal angulation was 3 deg. Eighty percent (8) of the fractures also had an intra-articular step-off
or gap, all of which were corrected to neutral by the procedure. Compared with the contralateral side, mean extension and
flexion were 73 and 75%, respectively, pronation and supination were 95 and 88%, respectively, and grip strength and thumb
pinch were 72 and 87%, respectively. Mean postoperative DASH score was 16 points, and 70% (7) of the patients had Gartland
and Werley scores of good or excellent. None of the patients needed to have their plates removed, and no extensor tendon rupture was reported.
Conclusions The “sandwich” plating technique is an effective method of regaining near-anatomic reconstruction of intra-articular, volarly
and dorsally comminuted distal radius fractures. Results from this study demonstrate that patients can expect to regain about
80% of their range of motion and strength. Moreover, 70% of the patients will have good to excellent functional outcomes. This is the first study to examine range of motion and functional outcome of low-profile “sandwich”
plating without plate removal. |
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Keywords: | Distal radius fracture Combined dorsal and volar plating Low-profile plating |
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