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

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.

Plate Fixation of AO Type C3 Fractures of the Distal Radius

PURPOSE: To evaluate clinical and radiographic results of open reduction and internal fixation with plate in AO type C3 distal radius fracture. MATERIALS AND METHODS: We treated 18 fractures and the mean follow up was 16 months. The average age was 47.1 years old, 12 male and 6 female were included. There were 9 C3.1 fracture, 5 C3.2 and 4 C3.3. Green & O'Brien's modified clinical scoring system and Demerit Point system were applied to evaluate clinical results, for radiographic evaluation, radial length, radial inclination, volar tilt, and Sarmiento's Criteria for Anatomic results were assessed. RESULTS: Clinical results were 5 of excellent, 7 of good, and 6 of fair by Green & O'Brien's score and were 5 of excellent, 6 of good, and 7 of fair by Demerit point. There was no significant difference of radiographic results between immediate postoperation and last follow-up, and Sarmiento's Criteria showed 8 excellent, 4 good, and 6 fair. CONCLUSION: The open reduction and internal fixation with plate in AO type C3 distal radius is considered as a good treatment method that particularly benefits from fracture stable fixation without fixation loss and early rehabilitation.