Radiographic Outcomes of Dorsal Spanning Plate for Treatment of Comminuted Distal Radius Fractures in Non-Elderly Patients.

Purpose: Multifragmentary fractures of the distal radius with articular and metaphyseal comminution (AO 23-C3) represent challenging injuries to manage. Distal fracture lines, articular comminution, and limited distal bone stock may preclude stable fixation with a volar locking plate. The use of a dorsal spanning plate (DSP) offers an alternative treatment option in this setting. We examined the radiographic outcomes of a consecutive series of patients with comminuted intra-articular distal radius fractures not amenable to volar locked plating, who were treated with a DSP. Methods: We reviewed all distal radius fractures treated with a dorsal spanning plate at our institution between October, 2014 and March, 2018. Patients with AO 23-C3 fractures treated with dorsal spanning plate fixation were included in this study. Demographic data, time from plate placement to removal, and postoperative radiographic outcomes were examined. Results: We identified 24 patients, mean age 41 years (range, 19-62 years). Mean follow-up was 19.5 weeks (range, 12-35 weeks) from the time of plate placement. Plates were removed at a mean of 87 days (range, 40-215 days) after surgery. All patients achieved radiographic union. Mean radial height at the time of union was 11.1 mm (SD, ±3.7 mm; range, 6-18 mm), radial inclination was 19.7° (SD, ±5.4°; range, 9° to 30°), ulnar variance was 1.0 mm (SD, ±2.4 mm; range, -3 to 6 mm), and volar tilt was 1.4° (SD, ±5.2°; range, -10° to 14°). Mean articular displacement was 1.7 mm (SD, ±1.7 mm; range, 0-6 mm). Malalignment of at least one of these radiographic parameters was identified in 16 of 24 patients at the time of union. Conclusions: Dorsal spanning plate fixation offers an alternative treatment option for comminuted intra-articular distal radius fractures (AO 23-C3). Although this technique presents a straightforward means for fixation of complex distal radius fractures, radiographic outcomes may be inferior relative to less complex fractures treated with standard volar plating techniques. Type of study/level of evidence: Therapeutic IV.