Authors’ Disclosure Statement: The authors report no actual or potential conflict of interest in relation to this article.
Acknowledgment: The authors would like to convey that this article is in dedication and in tribute to the life and career of Dean G. Lorich, MD.
Dr. Garner is an Assistant Professor, Milton S. Hershey Medical Center and Penn State College of Medicine, Hershey, Pennsylvania. Dr. Schottel is an Assistant Professor, University of Vermont Medical Center, South Burlington, Vermont. Mr. Thacher is a Medical Student, Columbia University College of Physicians and Surgeons, New York, New York. Dr. Warner is an Assistant Professor, University of Texas Health Science Center at Houston, Houston, Texas. Dr. Lorich was Associate Director of Orthopaedic Trauma Service, Hospital for Special Surgery; and Associate Professor of Orthopaedic Surgery, New York Presbyterian Hospital, Weill Cornell Medical College, New York, New York.
†Died December 10, 2017.
Address correspondence to: Matthew R. Garner, MD, Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA 17033 (tel 717-531-1363; email, Mgarner3@pennstatehealth.psu.edu).
Am J Orthop. 2018;47(3). Copyright Frontline Medical Communications Inc. 2018. All rights reserved.
Matthew R. Garner, MD Patrick C. Schottel, MD Ryan R. Thacher, BA Stephen J. Warner, MD, PhD Dean G. Lorich, MD† . Dual Radial Styloid and Volar Plating for Unstable Fractures of the Distal Radius. Am J Orthop. March 29, 2018
References
Although 1-year DASH scores for volar plating alone have been shown in the literature to be consistently within 6 and 13, 3-month and 6-month scores have historically been >18.22-27 Our short-term clinical results (Table 3) are comparable to these historic controls. Further, within our cohort there were no cases of nonunion, postoperative infection, or wound complications, and radiographic measures show maintenance of reduction at final follow-up (Table 2).
We do recognize that 36.1% (13/36) of our cohort had their distal radius implants removed. Although this incidence is high, it stems from the fact that patients who elect for implant removal are more likely to have had an atypical postoperative course and are therefore followed for longer than 6 months. Those who do not elect for removal are typically discharged from care after their 3-month postoperative visit, and were therefore not eligible for inclusion in this study. Overall, a total of 261 patients have been treated with this technique by the senior surgeon. Of those patients, only 28 (10.7%) underwent removal of surgical implants. If the remaining patients had been followed for the full 6 months, it is likely that outcome scores would have been skewed in a more favorable direction.
Surgeons electing to utilize radial styloid plating for displaced distal radius fractures should recognize that the required increased surgical dissection might lead to increased scar formation and postoperative stiffness. A limitation of this study is the lack of quantitative wrist ROM data. Future studies may compare final clinical outcomes and ROM for patients treated with and without radial column fixation.
CONCLUSION
We advocate for the use of a radial column plate as a tool to help achieve and maintain fracture reduction in the setting of an unstable distal radius fracture being treated with ORIF. This technique may be particularly useful when a surgical assistant is not available. Surgeons can expect clinical and radiographic results that are similar to those of volar locked plating alone.
