Supplemental metaphyseal fixation of severe comminuted distal radius fracture with a mini plate.

Abstract

Backgrounds: The treatment of complex distal radius fractures, particularly those involving both intra-articular disruption and significant metaphyseal comminution, remains a considerable surgical challenge. While volar locking plates have become a widely accepted standard for stabilizing these fractures, alone they may not address all fracture patterns. This study presents a surgical approach that incorporates the use of a mini-plate to provide targeted support for the metaphyseal region. We hypothesize that combining a mini-plate for metaphyseal stabilization with a volar locking plate for overall fracture fixation will enhance the structural stability and radiologic outcomes of metaphyseal comminuted distal radius fractures.

Subjects and methods: Eight cases of distal radius fractures involving comminution extending to the metaphysis treated surgically at Samsung Changwon Hospital during 2013-2023 were retrospectively analyzed. All patients had distal radius fractures with severe comminution at the metaphysis, where an added mini-plate was used to fix the fragments before applying the final volar locking plate. Using patient medical records, the mechanism of injury; presence of osteoporosis; type of fracture; radiologic parameters, final range of motion of the wrist; Mayo score and Disabilities of the Arm, Shoulder, and Hand (DASH) scores were investigated.

Results: The average age of the participants was 66 years. After a mean follow-up of 30.1 months, all patients achieved proper bone union. The median total range of motion of the wrist joint was 110.6° (40°-170°) at final follow-up. The radiographic parameters showed significant improvement postoperatively compared to preoperatively. The ulnar variance improved from a median of 5 mm to 0.5 mm (P = 0.013), the median teardrop angle increased from 33° to 59° (P = 0.012), and the median lateral palmar tilt improved from - 15.5° to 10.5° (P = 0.033). The median DASH score was 35.6 points, and the median Mayo score was 75.2 points.

Conclusion: By initially securing larger metaphyseal fragments with mini-plates, we transform a comminuted metaphyseal fracture into a simpler fracture pattern. This approach stabilizes the metaphyseal region, maintains radial length, and facilitates subsequent reduction of intra-articular fractures, thereby simplifying the surgical procedure. This method is a valuable addition to the surgical treatment options for managing such challenging fractures.