Outcomes in Dorsal Spanning Plates for the Management of Distal Radius Fractures

Purpose: To evaluate the outcomes of complex articular and periarticular distal radius fractures in isolated and polytraumatic injuries after management with dorsal spanning plates (DSP). Methods: We retrospectively reviewed 33 patients who underwent fixation with a dorsal spanning plate at a Level I trauma center between 2018 and 2023. Patient demographic information, comorbidities, fracture types, implant choices, postoperative complications, postremoval range of motion, and follow-up were analyzed. Within this sample, we also performed a subgroup analysis of polytrauma patients compared with patients experiencing from isolated fractures. Fracture type and morphology were classified with the Osteosynthesefragen (AO) Foundation and the Orthopaedic Trauma Association (OTA) system. Results: Of the 33 patients in our sample population, most patients were male [27 (81.8%)], and 15 (45.5%) experienced polytraumatic injuries. Partial articular fractures involving the scaphoid fossa (n = 6) and complete articular multi-fragmentary fractures extending into the diaphysis (n = 5) were most common. The average time between DSP hardware insertion and removal was 138.64 days, and that from removal to last follow-up was 167.4 days. Immediately after removal, average range of motion (ROM) was 36° flexion and 34.8° extension. We found no relationship between time to removal and postoperative ROM. There was no significant difference in postoperative ROM between polytrauma and nonpolytrauma patients. Two cases (6.1%) resulted in infection, and two (6.1%) required reoperation for secondary tenolysis secondary to that at time of removal. There were no instances of hardware failure or peri-hardware fracture. Conclusions: DSPs treat high-energy distal radius fractures well in isolated fracture and polytrauma patients. The absence of hardware failure and the comparatively low rate of infections and reoperations make these internal bridge plates useful. DSPs also may allow for earlier return to function with the ability for immediate weight bearing and temporary internal fixation for complex fracture types. Type of study/level of evidence: Therapeutic IV.