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A retrospective comparison of clinical and radiological outcomes using palmar or dorsal plating to treat complex intraarticular distal radius fractures (AO 2R3 C3)

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Abstract

Introduction

Complex intraarticular distal radius fractures are common, and treatment with open reduction and internal fixation (ORIF) can be done through either the palmar or dorsal approach. There is scant evidence, however, indicating which approach is more suitable. We compared clinical and radiological outcomes of patients with AO 2R3 C3 fractures surgically treated with one of these approaches.

Materials and methods

From January 2015 to November 2018, 72 surgically treated patients with AO 2R3 C3 fractures were radiologically (12 months) and clinically (mean 26 months) evaluated. Forty-one patients underwent ORIF using the palmar approach (Group 1), and the dorsal approach was used in 31 patients (Group 2). Radiological parameters were measured using the AO scoring system immediately following surgery and 12 months later. Clinical assessments included the range of motion, PRWE and DASH scores.

Results

At the immediate postoperative assessment, the median AO score was 5.5 (IQR 2–9.5, range 0–30.5) for Group 1 and 8 (IQR 5–15, range 0–27) for Group 2, and 12-month follow-up results were 4.5 (IQR 1.5–10, range 0–41) and 6.5 (IQR 5–11, range 0–29.5), respectively. Group 1 had more favorable results for the flexion, extension, radial abduction, PRWE and DASH parameters. The plate removal and reoperation rates were higher in Group 2.

Discussion

When treating complex intraarticular distal radius fractures, we found the palmar approach was more advantageous for this fracture pattern. Nevertheless, a dorsal approach may still be suitable for intraarticular comminuted distal radius fractures with dorsally displaced joint fragments.

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Authors and Affiliations

  1. Department of Orthopedic Surgery and Traumatology, Cantonal Hospital Frauenfeld, Pfaffenholzstrasse 4, 8501, Frauenfeld, Switzerland

    Christopher Child, Annika Müller, JoEllen Welter & Florian Hess

  2. Department of Trauma Surgery, University of Zurich, Zurich, Switzerland

    Florin Allemann & Hans-Christoph Pape

  3. Department of Radiology, Cantonal Hospital Frauenfeld, Frauenfeld, Switzerland

    Philipe Breiding

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  1. Christopher Child
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  2. Annika Müller
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Correspondence to Florian Hess.

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Annika Müller, Christopher Child, Florin Allemann, Hans-Christoph Pape, Philipe Breiding, JoEllen Welter, and Florian Hess declare that they have no conflict of interest.

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Child, C., Müller, A., Allemann, F. et al. A retrospective comparison of clinical and radiological outcomes using palmar or dorsal plating to treat complex intraarticular distal radius fractures (AO 2R3 C3). Eur J Trauma Emerg Surg 48, 4357–4364 (2022). https://doi.org/10.1007/s00068-020-01389-y

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