Plating of the Distal Radius

• Published in: Journal of the American Academy of Orthopaedic Surgeons Vol. 13; no. 3; pp. 159 - 171
• Main Authors: Nana, Arvind D, Joshi, Atul, Lichtman, David M
• Format: Journal Article
• Language: English
• Published: United States Am Acad Ortho Surgeons 01-05-2005
• Subjects: Bone Plates - adverse effects; Bone Plates - classification; Bone Screws; Equipment Design; Fracture Fixation, Internal - instrumentation; Fracture Fixation, Internal - methods; Humans; Radius Fractures - classification; Radius Fractures - surgery; Treatment Outcome
• ISSN: 1067-151X; 1940-5480
• DOI: 10.5435/00124635-200505000-00003

Dr. Nana is Staff Physician, Department of Orthopaedic Surgery, JPS Health Network, Fort Worth, TX. Dr. Joshi is Resident, Department of Orthopaedic Surgery, JPS Health Network. Dr. Lichtman is Chairman/Director, Department of Orthopaedic Surgery, JPS Health Network.
Reprint requests: Dr. Nana, JPS Health Network, 1500 South Main Street, Fort Worth, TX 76104.
Distal radius fractures are common injuries that can be treated by a variety of methods. Restoration of the distal radius anatomy within established guidelines yields the best short- and long-term results. Guidelines for acceptable reduction are (1) radial shortening <5 mm, (2) radial inclination >15°, (3) sagittal tilt on lateral projection between 15° dorsal tilt and 20° volar tilt, (4) intra-articular step-off <2 mm of the radiocarpal joint, and (5) articular incongruity <2 mm of the sigmoid notch of the distal radius. Treatment options range from closed reduction and immobilization to open reduction with plates and screws; options are differentiated based on their ability to reinforce and stabilize the three columns of the distal radius and ulna. Plating allows direct restoration of the anatomy, stable internal fixation, a decreased period of immobilization, and early return of wrist function. Buttress plates reduce and stabilize vertical shear intra-articular fractures through an antiglide effect, whereas conventional and locking plates address metaphyseal comminution and/or preserve articular congruity/reduction. With conventional and locking plates, intra-articular fractures are directly reduced; with buttress plates, the plate itself helps reduce the intra-articular fracture. Complications associated with plating include tendon irritation or rupture and the need for plate removal.