Radiographic and functional outcomes of dorsal-assisted volar plate fixation in comminuted intra-articular distal radius fractures: a prospective study.

OBJECTIVE

Comminuted intra-articular distal radius fractures (DRFs) present significant treatment challenges due to their complex morphology and tendency for post-traumatic arthritis. Volar plating alone may be insufficient to achieve and maintain reduction in dorsally displaced fractures. This prospective study evaluated the radiological and functional outcomes of dorsal-assisted volar plate fixation in dorsally displaced comminuted intra-articular DRFs.

METHODS

A total of 21 patients treated at a tertiary care trauma centre were enrolled. All underwent dorsal-assisted reduction followed by volar plating without dorsal instrumentation and were followed for a minimum of one year (mean follow-up: 19.6 ± 4.7 months). Radiological outcomes were assessed using radial height, radial inclination, volar tilt, and intra-articular step-off, while functional outcomes were measured using the QuickDASH and modified Mayo Wrist scores. The study was prospectively registered in the Department review board in department of Orthopaedic Surgery, PGIMER, under registration number DRB/Ortho/2023/49.

RESULTS

The mean patient age was 38 years, with a male predominance (17/21; 80.9%). Most fractures (15/21; 71.4%) were AO type 2R3C3. Postoperative evaluation demonstrated restoration of wrist alignment with a mean radial inclination of 23.35°, radial height of 11.29 mm, and volar tilt of 6.70°, closely approximating the uninjured wrist. Functional outcomes improved significantly from two months postoperatively to the final follow-up (P < 0.001), achieving a mean QuickDASH score of 4.95 and a modified Mayo Wrist Score of 90. Only two patients experienced minor complications related to implant prominence.

CONCLUSIONS

Dorsal-assisted volar plating is a safe and effective technique for managing dorsally displaced comminuted intra-articular distal radius fractures, providing excellent anatomical restoration and functional recovery with minimal complications. It offers a valuable surgical option where volar plating alone may be inadequate.