BACKGROUND:
Fractures of the distal part of the radius that are associated with complex
comminution of both the articular surface and the metaphysis (subgroup C3.2
according to the Comprehensive Classification of Fractures) are a challenge
for surgeons using standard operative techniques.
METHODS:
Twenty-five patients with subgroup-C3.2 fractures that had been treated
with combined dorsal and volar plate fixation were evaluated at an average of
twenty-six months after the injury. Subsequent procedures included implant
removal in twenty-one patients and reconstruction of a ruptured tendon in two
patients.
RESULTS:
An average of 54° of extension, 51° of flexion, 79° of
pronation, and 74° of supination were achieved. The grip strength in the
involved limb was an average of 78% of that in the contralateral limb. The
average radiographic measurements were 2° of dorsal angulation, 21° of
ulnar inclination, 0.8 mm of positive ulnar variance, and 0.7 mm of articular
incongruity. Seven patients had radiographic signs of arthrosis during the
follow-up period. A good or excellent functional result was achieved for
twenty-four patients (96%) according to the rating system of Gartland and
Werley and for ten patients (40%) according to the more stringent modified
system of Green and O'Brien.
CONCLUSIONS:
Combined dorsal and volar plate fixation of the distal part of the radius
can achieve a stable, mobile wrist in patients with very complex fractures.
The results are limited by the severity of the injury and may deteriorate with
longer follow-up. A second operation for implant removal is common, and there
is a small risk of tendon-related complications.