Physical Address

304 North Cardinal St.
Dorchester Center, MA 02124

Volar, Dorsal, and/or Radial Plating


Key Points

  • Volar plating is the workhorse of internal fixation for unstable distal radius fractures (DRFs)

  • Dorsal plate technology has improved, decreasing associated hardware-related complications

  • Combination plating is a viable option for highly unstable fracture patterns

  • Fixation strategy should ultimately be chosen based on fracture pattern and stability

Panel 1: Case Scenario

A 27-year-old right hand dominant male fell on his outstretched hand and sustained a highly comminuted intraarticular DRF. The fracture had dorsal, palmar, and radial comminution, with pieces of the articular surface impacted. He agreed to have surgical treatment. Which plating method is the most effective for this fracture: volar, dorsal, radial plating, or a combination plating configuration?

Importance of the Problem

DRFs are a common clinical problem with many treatment options available. Unstable and displaced or angulated DRFs are commonly treated with plate osteosynthesis. When considering options for fixation of DRFs, the optimal strategy will maximize function while minimizing complications. This chapter will explore the evidence for different types of plate fixation along with associated tradeoffs and complications.

Main Question

Which plating method is most effective for ORIF of displaced DRFs: volar, dorsal, radial, or a combination approach?

Current Opinion

Most unstable or displaced DRFs are treated with a locked volar plate. However, it is important that the treating surgeon be able to recognize situations in which a different fixation strategy is necessary to achieve stability.

Finding the Evidence

Below is a list of Pubmed search algorithms used to construct this chapter:

  • For Volar Plating : (“Radius Fractures” [Mesh] OR distal radius fracture*[tiab]) AND (“classification” [Subheading] OR displace* OR dislocat*) AND ((volar AND plating) OR “volar locking” OR “volar plating”)- (199 results)

  • For Dorsal Plating : (“Radius Fractures” [Mesh] OR distal radius fracture*[tiab]) AND (“classification” [Subheading] OR displace* OR dislocat*) AND (dorsal AND plating)- (83 results)

  • For Radial Plating : (“Radius Fractures” [Mesh] OR distal radius fracture*[tiab]) AND (“classification” [Subheading] OR displace* OR dislocat*) AND ((radial AND plating) OR “radial plating” OR “radial column plating” OR “radial styloid”)- (128 results)

  • For Combined Plating : (“Radius Fractures” [Mesh] OR distal radius fracture*[tiab]) AND (“classification” [Subheading] OR displace* OR dislocat*) AND ((combination AND plating) OR dual OR “fragment specific” OR “ulnar column”)- (32 results)

  • Pubmed Clinical Queries: systematic[sb] AND (Distal radius plating) (6 results), systematic[sb] AND (Distal radius classification) (10 results), systematic[sb] AND (displaced distal radius) (19 results)

  • Cochrane Database of Systematic Reviews: Displaced distal radius (19 results), distal radius plating (12 results), distal radius classification (26 results)

Quality of the Evidence

Level I:

  • Randomized Controlled Trial: 1

Level II:

  • Prospective Cohort Studies: 5

  • Systematic Review of Cohort Studies: 1

  • Randomized Trial with methodological limitations: 1

  • Outcomes Research: 1

Level III:

  • Retrospective Cohort Studies: 14

  • Systematic Review of Case-Controlled Studies: 1

Level IV:

  • Case Series: 1

Level V:

  • Expert Opinion: 1

Findings

Volar Plating

Volar plating has risen to prominence as the preferred choice among most surgeons for internal fixation of DRFs. The technique has been applied to a wide variety of fracture patterns and patient populations with successful radiographic and functional outcomes and a low complication rate.

Fracture Pattern and Displacement

Volar plating can be used successfully to treat a variety of fracture types and patterns of displacement. Both volar and dorsal displacement are amenable to volar plating, as are extraarticular, partial articular, and intraarticular patterns. Erhart et al. studied whether the direction of fracture displacement, dorsal or volar, affected radiographic and clinical outcomes following volar plating. They evaluated 50 patients who underwent volar plating, half of whom had dorsally displaced (Colles) and half with volarly displaced (Smith) fractures. At a mean follow-up of 5 years postoperatively, they found no significant clinical difference between the groups. All patients had progression of arthrosis thought to be secondary to the injury itself. The dorsally displaced group had a trend toward restriction of flexion if the final position had residual dorsal tilt, although this did not affect function.

Braziulis et al. found that all fracture types (AO Types A, B, and C) had improved function and radiographic parameters at 6-months of follow-up following volar plating. Patients with complete articular fractures had worse DASH scores and radiographic parameters than the other two groups, but all were improved from their preoperative status.

You're Reading a Preview

Become a Clinical Tree membership for Full access and enjoy Unlimited articles

Become membership

If you are a member. Log in here