Abstract
Purpose
To determine if distraction bridge plate (DBP) fixation as the primary method of stabilization can effectively correct and maintain acceptable radiographic parameters in the treatment of comminuted, intra-articular distal radius fractures while allowing early load-bearing.
Methods
A retrospective review was performed of all consecutive intra-articular distal radius fractures that underwent DBP fixation with or without supplemental fixation methods (fragment-specific implants or K-wires). Patients treated with a volar locked plate in addition to DBP were excluded. Radiographic outcomes measures included volar tilt (°), radial height (mm), radial inclination (°), articular step-off (mm), lunate-lunate facet ratio (LLFR), and teardrop angle (°) measured on post-reduction, immediately post-operative, prior to and after DBP removal.
Results
Twenty-three comminuted, intra-articular distal radius fractures were treated with primary DBP fixation. Supplemental fixation was utilized in 10 fractures and included fragment-specific implants (n = 6) and/or K-wires (n = 5). Distraction bridge plates were removed after a mean of 13.6 weeks. At a mean radiographic follow-up of 11.4 weeks (range: 2–45 weeks) following DBP removal, all fractures had united with a mean volar tilt of 6.3° ± 5.8°, radial height of 11.3 ± 2.3 mm, radial inclination of 20.2° ± 4.5°, articular step-off of 0.6 mm ± 0.8, and LLFR of 1.05 ± 0.06. However, the teardrop angle could not be restored to a normal value with DBP fixation. Complications included 1 plate breakage and 1 peri-hardware radial shaft fracture.
Conclusion
Distraction bridge plate fixation is a reliable method to stabilize highly comminuted, intra-articular distal radius fractures in patients with a well-aligned volar rim fragment of the lunate facet.
Graphical Abstract
Similar content being viewed by others
Data availability statement
A limited data set without protected health information can be available for any disputes.
References
Beck, J. D., Harness, N. G., & Spencer, H. T. (2014). Volar plate fixation failure for volar shearing distal radius fractures with small lunate facet fragments. Journal of Bone and Joint Surgery. American Volume, 39(4), 670–678.
Harness, N. G., Jupiter, J. B., Orbay, J. L., Raskin, K. B., & Fernandez, D. L. (2004). Loss of fixation of the volar lunate facet fragment in fractures of the distal part of the radius. Journal of Bone and Joint Surgery. American Volume, 86(9), 1900–1908.
Ginn, T. A., Ruch, D. S., Yang, C. C., & Hanel, D. P. (2006). Use of a distraction plate for distal radial fractures with metaphyseal and diaphyseal comminution. Surgical technique. Journal of Bone and Joint Surgery. American Volume, 88(Suppl 1 Pt 1), 29–36.
Ruch, D. S., Ginn, T. A., Yang, C. C., Smith, B. P., Rushing, J., & Hanel, D. P. (2005). Use of a distraction plate for distal radial fractures with metaphyseal and diaphyseal comminution. Journal of Bone and Joint Surgery. American Volume, 87(5), 945–954.
Yuan, Z. Z., Yang, Z., Liu, Q., & Liu, Y. M. (2018). Complications following open reduction and internal fixation versus external fixation in treating unstable distal radius fractures: Grading the evidence through a meta-analysis. Orthopaedics & Traumatology: Surgery & Research, 104(1), 95–103.
Dicpinigaitis, P., Wolinsky, P., Hiebert, R., & Egol, K. A. (2004). Can external fixation maintain reduction after distal radius fractures? Journal of Trauma, 57(4), 845–850.
Hanel, D. P., Lu, T. S., & Weil, W. M. (2006). Bridge plating of distal radius fractures: The Harborview method. Clinical Orthopaedics and Related Research, 445, 91–99.
Becton, J. L., Colborn, G. L., & Goodrich, J. A. (1998). Use of an internal fixator device to treat comminuted fractures of the distal radius: Report of a technique. American Journal of Orthopedics, 27(9), 619–623.
Lauder, A., Agnew, S., Bakri, K., Allan, C. H., Hanel, D. P., & Huang, J. I. (2015). Functional outcomes following bridge plate fixation for distal radius fractures. Journal of Bone and Joint Surgery. American Volume, 40(8), 1554–1562.
Lichtman, D. M., Bindra, R. R., Boyer, M. I., Putnam, M. D., Ring, D., Slutsky, D. J., Taras, J. S., Watters, W. C., III., Goldberg, M. J., Keith, M., Turkelson, C. M., Wies, J. L., Haralson, R. H., III., Boyer, K. M., Hitchcock, K., Raymond, L., AAOS. (2011). American Academy of Orthopaedic Surgeons clinical practice guideline on: The treatment of distal radius fractures. Journal of Bone and Joint Surgery. American Volume, 93(8), 775–778.
Richard, M. J., Katolik, L. I., Hanel, D. P., Wartinbee, D. A., & Ruch, D. S. (2012). Distraction plating for the treatment of highly comminuted distal radius fractures in elderly patients. Journal of Bone and Joint Surgery. American Volume, 37(5), 948–956.
Medoff, R. J. (2005). Essential radiographic evaluation for distal radius fractures. Hand Clinics, 21(3), 279–288.
Harreld, K. L., Apel, P., Koman, L. A., & Li, Z. (2009). Lunate-lunate facet ratio and variance to predict articular gap after distal radius fracture. Journal of Bone and Joint Surgery. American Volume, 34(9), 1625–1632.
Fujitani, R., Omokawa, S., Iida, A., et al. (2012). Reliability and clinical importance of teardrop angle measurement in intra-articular distal radius fractures. Journal of Hand Surgery, 37A(3), 454–429.
Piennar, G., Anley, C., Ikram, A., et al. (2013). Restroation of teardrop angle (TDA) in distal radius fractures treated with volar locking plates. SA Orthopaedic Journal., 12(3), 32–34.
Rhee, P. C., Medoff, R. J., & Shin, A. Y. (2017). Complex distal radius fractures: An anatomic algorithm for surgical management. JAAOS, 25(2), 77–88.
Anderson, J. T., Lucas, G. L., & Buhr, B. R. (2004). Complications of treating distal radius fractures with external fixation: A community experience. Iowa Orthopaedic Journal, 24, 53–59.
Weber, S. C., & Szabo, R. M. (1986). Severely comminuted distal radial fracture as an unsolved problem: Complications associated with external fixation and pins and plaster techniques. Journal of Bone and Joint Surgery. American Volume, 11(2), 157–165.
Sanders, R. A., Keppel, F. L., & Waldrop, J. I. (1991). External fixation of distal radial fractures: Results and complications. Journal of Bone and Joint Surgery. American Volume, 16(3), 385–391.
Yang, Z., Yuan, Z. Z., Ma, J. X., & Ma, X. L. (2016). Complications of open reduction and internal fixation versus external fixation for unstable distal radius fractures: A meta-analysis. Zhonghua Yi Xue Za Zhi, 96(47), 3833–3837.
Rhee, P. C., Dennison, D. G., & Kakar, S. (2012). Avoiding and treating perioperative complications of distal radius fractures. Hand Clinics, 28(2), 185–198.
Papadonikolakis, A., & Ruch, D. S. (2005). Internal distraction plating of distal radius fractures. Techniques in Hand & Upper Extremity Surgery, 9(1), 2–6.
Mandziak, D. G., Watts, A. C., & Bain, G. I. (2011). Ligament contribution to patterns of articular fractures of the distal radius. Journal of Bone and Joint Surgery. American Volume, 36(10), 1621–1625.
Zumstein, M. A., Hasan, A. P., McGuire, D. T., Eng, K., & Bain, G. I. (2013). Distal radius attachments of the radiocarpal ligaments: An anatomical study. Journal of Wrist Surgery, 2(4), 346–350.
Bain, G. I., Alexander, J. J., Eng, K., Durrant, A., & Zumstein, M. A. (2013). Ligament origins are preserved in distal radial intraarticular two-part fractures: A computed tomography-based study. Journal of Wrist Surgery, 2(3), 255–262.
Hanel, D. P., Ruhlman, S. D., Katolik, L. I., & Allan, C. H. (2010). Complications associated with distraction plate fixation of wrist fractures. Hand Clinics, 26(2), 237–243.
Papadonikolakis, A., Shen, J., Garrett, J. P., Davis, S. M., & Ruch, D. S. (2005). The effect of increasing distraction on digital motion after external fixation of the wrist. The Journal of Hand Surgery. American Volume, 30(4), 773–779.
Stirling, E., Jeffery, J., Johnson, N., & Dias, J. (2016). Are radiographic measurements of the displacement of a distal radial fracture reliable and reproducible? The Bone and Joint Journal, 98-B(8), 1069–1073.
Watson, N. J., Asadollahi, S., Parrish, F., et al. (2016). Reliability of radiographic measurements for acute distal radius fractures. BMC Medical Imaging., 16, 44.
Wolf, J. C., Weil, W. M., Hanel, D. P., et al. (2006). A biomechanical comparison of an internal radiocarpal-spanning 2.4-mm locking plate and external fixaton in a model of distal radius fractures. The Journal of Hand Surgery. American, 31(10), 1578–1586.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
On behalf of all authors, the corresponding author states that there is no conflict of interest.
Ethical Standard
This article does not contain any studies with human or animal subjects performed by the any of the authors.
Informed Consent
This study was approved by the institutional review board and was performed with patient informed consent.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Rambau, G.M., Sgromolo, N. & Rhee, P.C. Radiographic Outcomes for Comminuted, Intra-articular Distal Radius Fractures Treated with Primary Distraction Bridge Plate Fixation. JOIO 57, 543–551 (2023). https://doi.org/10.1007/s43465-022-00812-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s43465-022-00812-3