gms | German Medical Science

Objectives/Interrogation: Marginal intra-articular distal radius fractures pose a significant challenge to the treating surgeon, small fracture fragments that are distal to the watershed line represent a clinical challenge. Stability of the marginal rim fracture is critical to provide structural support of the carpus, and failure to maintain reduction of this fragment can lead to catastrophic volar carpal subluxation or dislocation. The objective of this study was to evaluate the outcomes of distal radius fractures treated with a new fragment-specific plate.

Methods: A consecutive series of 10 patients who sustained distal radius fractures underwent radial column plating alone or in conjunction with other implants, between May 2016 and August 2018. For all patients, radiographs were obtained in standard anteroposterior and lateral projections associated with CT, which allowed to identify and describe the fragment. All patients were treated surgically with reduction and fragment synthesis using Medartis® Hook Plates 1.5. After the surgery the patients kept a splint for 3 weeks, then starting a rehabilitation program of physiokinetic therapy. All patients were evaluated with post-operative radiographs and at 1, 3 and 6 months. We also evaluated the articular range of motion in flexion-extension and in prono-supination and strength with the Jamar test, comparing the results with the contralateral wrist.

Results and Conclusions: The average follow-up was 15 months (2 - 24 months). Clinical checks show a progressive improvement in strength and symptomatology and a 92% mean ROM recovery compared to the contralateral side. In 6 cases an standard plate from APTUS® Wrist Distal Radius System 2.5 was associated, in 3 cases K wires were associated (one of them with also external fixation associated), for 2 patients two mini anchors (Mitek®) were used to stabilize the ligaments. In only one case it was necessary to remove the plate which occurred following the mobilization of a screw. All patients returned to their work-recreational activities prior to the trauma. There was no case of dislocation or secondary loss of reduction. All the control radiographs showed the restoration and maintenance of joint congruence at the radiocarpic level. In conclusion: radial column plating of the distal radius is a safe treatment modality and a valuable adjunct in the setting of complex distal radius fractures with few complications and objective scores consistent with return to normal function.