Fixation of 3-Part Intra Articular Distal Radius Fracture with Combined Volar Plate and Dorsal Spanning Plate: A Case Report.

INTRODUCTION: The aim of this study is to illustrate a case in which the use of a dorsal spanning plate followed by volar plating may be indicated in the setting of a complex intra-articular distal radius fracture. Combined dorsal spanning plate and volar plating is a rare procedure reserved typically for comminuted fractures of the distal radius. This case highlights the first reported incidence in which a dorsal spanning plate of a distal radius fracture resulted in the volar displacement of the fragments, requiring subsequent volar plating. In the end, the outcome was favorable, as the follow-up imaging displayed good bone healing and union with minimal complications.

CASE REPORT: A 52-year-old male presented to the ED at our institution following a traumatic fall onto his left upper extremity. Radiographic imaging revealed fractures at the midshaft of the humerus as well as a very distal three-part intra-articular radius fracture. Due to the nature of the patient's distal radius fracture, initial fixation with a dorsal spanning plate was planned. However, follow-up imaging 3 weeks postoperatively revealed volar displacement of his fracture, so the patient underwent open reduction internal fixation with a volar distal radius plate. Follow-up over the next few months displayed a union of the fracture fragments and the dorsal spanning plate was removed 4 months postoperatively with imaging showing no complications.

CONCLUSION: We present this case to highlight the complication of volar displacement that may follow initial dorsal spanning plate fixation of a three-part intra-articular distal radius fracture that can be resolved with the addition of a volar plate, as well as possible indications for combined dorsal spanning plate and volar plate fixation of complex distal radius fractures at the time of initial fixation.