Clinical and Radiographic Outcomes of Distal Radius Fractures Following Dorsal Bridge Fixation to the Second Versus Third Metacarpal.

Abstract

Purpose: Dorsal bridge plating (DBP) can effectively treat complex distal radius fractures (DRFs); however, techniques for metacarpal fixation vary. The purpose of our study was to compare range of motion (ROM), grip strength, patient-reported outcomes, radiographic parameters, and complication rates between patients undergoing DBP with fixation to the second versus third metacarpal for DRFs.

Methods: We retrospectively analyzed 432 patients with DRFs. Wrist ROM and radiographic data were calculated at the 6-month follow-up. We calculated Patient-Reported Outcomes Measurement Information System (PROMIS) upper-extremity, physical function, and pain interference at each visit. Additional data collected included surgical complications and demographic data. Statistical analysis was conducted via multivariate analysis, t tests, and chi-square tests.

Results: A total of 329 patients underwent DBP to the second metacarpal, whereas 103 patients underwent DBP to the third. Demographics and comorbidities were similar between the groups. Tendon rupture was more common in the third metacarpal group (3.9% vs 0.9%), with two extensor pollicis longus and one extensor indicis proprius ruptures in each group and an unspecified tendon in the third metacarpal cohort. All other complication rates were similar. The second metacarpal group demonstrated greater wrist flexion (57.8° vs 56.2°), ulnar deviation (23.9° vs 20.7°), and grip strength (62.3% vs 57.8%). All other ROM measurements were similar. There was no difference in PROMIS metrics at the 6-month follow-up. The second metacarpal group demonstrated greater radial inclination (21.3° vs 19.5°) and less volar tilt (6.8° vs 7.1°).

Conclusions: Dorsal bridge plating to the second metacarpal demonstrated greater ROM, grip strength, and radial inclination, similar PROMIS scores, and lower extensor tendon rupture rates than third metacarpal fixation. Although there were differences between techniques, their clinical relevance is unclear. Dorsal bridge plating to the second or third metacarpal both result in acceptable outcomes and can be considered based on the fracture pattern and surgeon preference.

Type of study/level of evidence: Therapeutic IV.