Dorsal or Volar Plate Fixation of the Distal Radius: Does the Complication Rate Help Us to Choose?

Abstract

Background Internal fixation with plates is a reliable fixation technique for the treatment of distal radius fractures. An ongoing discussion exists whether volar or dorsal plating is the appropriate technique. In clinical practice, volar plate fixation is usually preferred because of the assumed lower complication frequency. However, recent studies with the newer generation low-profile dorsal plates reported lower complication rates.

Purpose The aim of our study was to evaluate the differences in complication rates between volar and dorsal plate for the treatment of distal radius fractures in adult patients.

Patients and Methods A total of 214 patients with acute distal radius fractures were included in this retrospective study with a minimum 2 years of follow-up. In total, 123 patients were treated with dorsal plate fixation and 91 patients with volar plate fixation. Our primary study outcome was complication rate.

Results The overall risk for complications was 15.4% in the dorsal group and 14.3% in the volar group (p = 0.81). A total of 19 patients had implant removal due to complications: 11 patients in the dorsal group and 8 patients in the volar group (p = 0.97).

Conclusion There is no preferred plate fixation technique based on these study results. In our opinion, decision for type of plate fixation should be based on fracture type and surgeon's experience with the specific approach and plate types.

Level of Evidence Therapeutic level III.

Keywords

distal radius fractures - internal fixation - dorsal plates - volar plates - complications

• References

• 1 Court-Brown CM, Caesar B. Epidemiology of adult fractures: a review. Injury 2006; 37 (8) 691-697
• 2 Handoll HH, Madhok R. WITHDRAWN: Surgical interventions for treating distal radial fractures in adults. Cochrane Database Syst Rev 2009; (3) CD003209
• 3 Wei J, Yang TB, Luo W, Qin JB, Kong FJ. Complications following dorsal versus volar plate fixation of distal radius fracture: a meta-analysis. J Int Med Res 2013; 41 (2) 265-275
• 4 Martineau PA, Berry GK, Harvey EJ. Plating for distal radius fractures. Orthop Clin North Am 2007; 38 (2) 193-201 , vi
• 5 Ruch DS, Papadonikolakis A. Volar versus dorsal plating in the management of intra-articular distal radius fractures. J Hand Surg Am 2006; 31 (1) 9-16
• 6 Tavakolian JD, Jupiter JB. Dorsal plating for distal radius fractures. Hand Clin 2005; 21 (3) 341-346
• 7 Jakubietz MG, Gruenert JG, Jakubietz RG. Palmar and dorsal fixed-angle plates in AO C-type fractures of the distal radius: is there an advantage of palmar plates in the long term?. J Orthop Surg 2012; 7 (1) 8
• 8 Day CS, Franko OI. Low-profile dorsal plating for dorsally angulated distal radius fractures. Tech Hand Up Extrem Surg 2007; 11 (2) 142-148
• 9 Kamath AF, Zurakowski D, Day CS. Low-profile dorsal plating for dorsally angulated distal radius fractures: an outcomes study. J Hand Surg Am 2006; 31 (7) 1061-1067
• 10 Orbay JL, Fernandez DL. Volar fixation for dorsally displaced fractures of the distal radius: a preliminary report. J Hand Surg Am 2002; 27 (2) 205-215
• 11 Kamano M, Honda Y, Kazuki K, Yasuda M. Palmar plating for dorsally displaced fractures of the distal radius. Clin Orthop Relat Res 2002; (397) 403-408
• 12 Vasenius J. Operative treatment of distal radius fractures. Scand J Surg 2008; 97 (4) 290-296 , discussion 296–297
• 13 Yu YR, Makhni MC, Tabrizi S, Rozental TD, Mundanthanam G, Day CS. Complications of low-profile dorsal versus volar locking plates in the distal radius: a comparative study. J Hand Surg Am 2011; 36 (7) 1135-1141
• 14 Matschke S, Wentzensen A, Ring D, Marent-Huber M, Audigé L, Jupiter JB. Comparison of angle stable plate fixation approaches for distal radius fractures. Injury 2011; 42 (4) 385-392
• 15 Chou YC, Chen AC, Chen CY, Hsu YH, Wu CC. Dorsal and volar 2.4-mm titanium locking plate fixation for AO type C3 dorsally comminuted distal radius fractures. J Hand Surg Am 2011; 36 (6) 974-981
• 16 Wichlas F, Haas NP, Disch A, Machó D, Tsitsilonis S. Complication rates and reduction potential of palmar versus dorsal locking plate osteosynthesis for the treatment of distal radius fractures. J Orthop Traumatol 2014; 15 (4) 259-264
• 17 Zettl RP, Clauberg E, Nast-Kolb D, Ruchholtz S, Kühne CA. Volar locking compression plating versus dorsal plating for fractures of the distal radius: a prospective, randomized study [in German]. Unfallchirurg 2009; 112 (8) 712-718
• 18 Lafontaine M, Hardy D, Delince P. Stability assessment of distal radius fractures. Injury 1989; 20 (4) 208-210
• 19 Altissimi M, Mancini GB, Azzarà A, Ciaffoloni E. Early and late displacement of fractures of the distal radius. The prediction of instability. Int Orthop 1994; 18 (2) 61-65
• 20 Gustilo RB, Mendoza RM, Williams DN. Problems in the management of type III (severe) open fractures: a new classification of type III open fractures. J Trauma 1984; 24 (8) 742-746
• 21 Hudak PL, Amadio PC, Bombardier C ; The Upper Extremity Collaborative Group (UECG). Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand) [corrected]. Am J Ind Med 1996; 29 (6) 602-608
• 22 MacDermid JC, Turgeon T, Richards RS, Beadle M, Roth JH. Patient rating of wrist pain and disability: a reliable and valid measurement tool. J Orthop Trauma 1998; 12 (8) 577-586
• 23 Changulani M, Okonkwo U, Keswani T, Kalairajah Y. Outcome evaluation measures for wrist and hand: which one to choose?. Int Orthop 2008; 32 (1) 1-6
• 24 Rondinelli RD, Katz RT. Guides to the Evaluation of Permanent Impairment. 5th ed. Chicago, IL: American Medical Association; 2007
• 25 Mathiowetz V, Weber K, Volland G, Kashman N. Reliability and validity of grip and pinch strength evaluations. J Hand Surg Am 1984; 9 (2) 222-226
• 26 van Eerten PV, Lindeboom R, Oosterkamp AE, Goslings JC. An X-ray template assessment for distal radial fractures. Arch Orthop Trauma Surg 2008; 128 (2) 217-221
• 27 Müller M. The principle of the classification. In: Müller ME, Allgöwer M, Schneider R, Willenegger H, eds. Manual of Internal Fixation: Techniques Recommended by the AO-ASIF Group. New York, NY: Springer-Verlag; 1991: 118
• 28 Andersen DJ, Blair WF, Steyers Jr CM, Adams BD, el-Khouri GY, Brandser EA. Classification of distal radius fractures: an analysis of interobserver reliability and intraobserver reproducibility. J Hand Surg Am 1996; 21 (4) 574-582