Volar locked plating versus dorsal bridge plating for complete articular (AO/OTA type 23C) distal radius fractures.

BACKGROUND

Volar locked plating (VLP) and dorsal bridge plating (DBP) are both appropriate surgical strategies for the treatment of complete articular distal radius fractures (DRFs), however, direct comparisons between these fixation methods in this injury pattern is lacking.

PURPOSE: The purpose of this study was to compare functional, radiographic, and patient-reported outcomes, for complete articular (AO/OTA 23C) DRFs treated with VLP versus dorsal bridge plating DBP.

METHODS

This was a retrospective cohort study that included patients aged 18-90 years old who underwent VLP or DBP fixation for AO/OTA 23C DRFs. Polytraumatized patients and those undergoing revision surgery were excluded. Wrist range of motion (ROM) and radiographic outcome measures were collected at 6-month follow-up. PROMIS Upper Extremity (UE), Physical Function (PF), and Pain Interference (PI) were obtained at each follow-up. Surgical complications and patient demographic data were recorded.

RESULTS

After propensity matching, 1069 VLP patients were matched to 214 DBP individuals, rendering all demographic variables examined comparable. DBP patients had higher rates of delayed union(2.0 % vs. 4.2 %; p < 0.05) and tendon rupture (0.5 % vs. 3.3 %; p < 0.05), but similar rates of revision surgery, malunion, and infection at 6-months. Multivariate analysis demonstrated greater wrist flexion, extension, radial and ulnar deviation, supination, protonation, grip strength, PROMIS UE, and PROMIS PF among the VLP group compared to DBP (p < 0.05). VLP patients also demonstrated greater radial height and radial inclination, less articular step-off, and decreased volar tilt (p < 0.05).

CONCLUSIONS

VLP was associated with greater ROM, grip strength, PROMIS UE and PF, improved radial height, radial inclination, and less articular step-off and volar tilt at 6-month follow-up compared to DBP. DBP patients also demonstrated higher rates of delayed union and tendon rupture but similar complication rates.

LEVEL OF EVIDENCE: Therapeutic III.