Surgical treatment of fractures of the distal radius with plates: a comparison of palmar and dorsal plate position

Introduction. While most fractures of the distal radius can be treated successfully by conservative means, some fractures-especially the more complicated fracture types-require surgical fixation. One of the operative techniques is plate osteosynthesis, which can be performed in either a dorsal or a palmar plate position. Materials and methods. This study reports on 122 fractures of the distal radius treated by open reduction and internal fixation with the T-plate, investigating the long-term outcome after an average period of 42.4 months. The follow-up examination contained a subjective, a clinical and a radiological part, and the results were evaluated according to the scores of Stewart and of Castaing with special emphasis on the question of whether palmar or dorsal plating showed any differences in outcome, and if so, what they were. Results. The radiological results (Stewart 1 score; i.e. the anatomical reduction) were 'excellent' or 'good' in 87.7% of cases. There were significant differences with respect to age, gender and plate position: patients older than 80 years and women had significantly worse results, and dorsal plating was significantly better than palmar plating. The functional outcome (Stewart 2 score) was 'excellent' and 'good' in 90.2% of cases. These functional results showed a tendency for dorsal plating to be better, but the differences were not significant. There was a close correlation between the radiological and the clinical findings. With the Castaing score, which combines both functional and radiological outcomes, there were 73.8% perfect and good results. Conclusion. This study shows that the majority of patients with problem fractures of the distal radius can be successfully treated by internal fixation using the T-plate. The dorsal approach to the distal radius-in cases where dorsal plating is appropriate-will result in a better anatomical reduction and clinical outcome.