Background: Fractures of the distal part of the radius that are
associated with complex comminution of both the articular surface and the
metaphysis (subgroup C3.2 according to the Comprehensive Classification of
Fractures) are a challenge for surgeons using standard operative
Methods: Twenty-five patients with subgroup-C3.2 fractures that had
been treated with combined dorsal and volar plate fixation were evaluated at
an average of twenty-six months after the injury. Subsequent procedures
included implant removal in twenty-one patients and reconstruction of a
ruptured tendon in two patients.
Results: An average of 54° of extension, 51° of flexion,
79° of pronation, and 74° of supination were achieved. The grip
strength in the involved limb was an average of 78% of that in the
contralateral limb. The average radiographic measurements were 2° of
dorsal angulation, 21° of ulnar inclination, 0.8 mm of positive ulnar
variance, and 0.7 mm of articular incongruity. Seven patients had radiographic
signs of arthrosis during the follow-up period. A good or excellent functional
result was achieved for twenty-four patients (96%) according to the rating
system of Gartland and Werley and for ten patients (40%) according to the more
stringent modified system of Green and O'Brien.
Conclusions: Combined dorsal and volar plate fixation of the distal
part of the radius can achieve a stable, mobile wrist in patients with very
complex fractures. The results are limited by the severity of the injury and
may deteriorate with longer follow-up. A second operation for implant removal
is common, and there is a small risk of tendon-related complications.
Level of Evidence: Therapeutic study, Level IV (case
series [no, or historical, control group]). See Instructions to Authors for a
complete description of levels of evidence.