Bridge Plate Distraction for Complex Distal Radius Fractures: A Cohort Study and Systematic Review of the Literature

Abstract Background  Dorsal bridge plating (DP) of the distal radius is used as a definitive method of stabilization in complex fracture configurations and polytrauma patients. Questions/Purposes  This review aims to summarize the current understanding of DP and evaluate surgical outcomes. Methods  Four databases were searched following the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines and registered with PROSPERO. Papers presenting outcome or complication data for DP were included. These were reviewed using the National Institutes of Health Quality Assessment and Methodological Index for Non-Randomised Studies tools. Results were collated and compared to a local cohort of DP patients. Results  Literature review identified 416 patients with a pooled complication rate of 17% requiring additional intervention. The most prevalent complications were infection/wound healing issues, arthrosis, and hardware failure. Average range of motion was flexion 46.5 degrees, extension 50.7 degrees, ulnar deviation 21.4 degrees, radial deviation 17.3 degrees, pronation 75.8 degrees, and supination 72.9 degrees. On average, DP removal occurred at 3.8 months. Quality assessment showed varied results. There were 19 cases in our local cohort. Ten displayed similar results to the systematic review in terms of range of motion and radiographic parameters. Higher QuickDASH scores and complication rates were noted. Local DP showed earlier plate removal at 2.9 months compared to previous studies. Conclusion  DP is a valid and useful technique for treating complex distal radius fractures. It displays a lower risk of infection and pain compared to external fixation which is commonly used to treat similar injuries. Patients can recover well following treatment both in function and range of motion. Further high-quality studies are required to fully evaluate the technique.

[1]  D. Fufa,et al.  Radius distraction during volar plating of distal radius fractures may improve distal radioulnar joint stability at minimum 3-year follow-up: a retrospective case series study , 2022, BMC Musculoskeletal Disorders.

[2]  M. Mohamed,et al.  SPANNING PLATE IN FIXATION OF COMMINUTED DISTAL RADIUS FRACTURE , 2021, Egyptian Journal of Orthopedic Research.

[3]  P. Divall,et al.  Origins of the threshold for surgical intervention in intra-articular distal radius fractures. , 2021, The bone & joint journal.

[4]  Ann S. Golden,et al.  Distal Radius Fractures and the Dorsal Spanning Plate in the Management of the Polytraumatized Patient , 2021, Journal of orthopaedic trauma.

[5]  R. Babst,et al.  The spanning plate as an internal fixator in complex distal radius fractures: a prospective cohort study , 2021, European Journal of Trauma and Emergency Surgery.

[6]  G. Gallucci,et al.  Dorsal Plating for Specific Fracture Pattern of the Distal Radius. , 2021, The journal of hand surgery Asian-Pacific volume.

[7]  N. Schep,et al.  Temporary spanning plate wrist fixation of complex distal radius fractures: a systematic review of 353 patients , 2021, European Journal of Trauma and Emergency Surgery.

[8]  F. Schuind,et al.  Normative values of the DASH questionnaire in healthy individuals over 50 years of age. , 2021, Hand surgery & rehabilitation.

[9]  L. Nesti,et al.  Dorsal Bridge Plate for Distal Radius Fractures: A Systematic Review. , 2021, The Journal of hand surgery.

[10]  P. Beredjiklian,et al.  Early Retrieval of Spanning Plates Used for Fixation of Complex Fractures of the Distal Radius , 2021, Journal of Wrist Surgery.

[11]  R. Babst,et al.  Role of a spanning plate as an internal fixator in complex distal radius fractures , 2020, Operative Orthopädie und Traumatologie.

[12]  Yingze Zhang,et al.  Wrist Fracture , 2020, Differential Diagnosis of Fracture.

[13]  D. Ruch,et al.  Dorsal Wrist Spanning Plate Fixation for Treatment of Radiocarpal Fracture-Dislocations , 2019, Hand.

[14]  Scott A. Mitchell,et al.  Radiographic Outcomes of Dorsal Spanning Plate for Treatment of Comminuted Distal Radius Fractures in Non-Elderly Patients , 2019, Journal of hand surgery global online.

[15]  A. Ilyas,et al.  Dorsal Bridge Plating versus External Fixation for Distal Radius Fractures , 2019, Journal of Wrist Surgery.

[16]  M. Aita,et al.  Bridging versus Nonbridging Dynamic External Fixation of Unstable Distal Radius Fractures in the Elderly with Polytrauma: A Randomized Study , 2019, Journal of Wrist Surgery.

[17]  P. Henry,et al.  The use of dorsal distraction plating for severely comminuted distal radius fractures: A review and comparison to volar plate fixation. , 2019, Injury.

[18]  D. Hanel,et al.  Bridge Plating for Distal Radius Fractures in Low-Demand Patients With Assist Devices. , 2019, The Journal of hand surgery.

[19]  K. Chung,et al.  Assessment of Anatomic Restoration of Distal Radius Fractures Among Older Adults , 2019, JAMA network open.

[20]  M. Stevanovic,et al.  Bridge Plate Failure with Extensor Tendon Injury: A Case Report and Literature Review , 2018, Case reports in orthopedics.

[21]  M. Stevanovic,et al.  Review of Internal Radiocarpal Distraction Plating for Distal Radius Fracture Fixation , 2018, Hand.

[22]  Safa T. Herfat,et al.  Biomechanical Assessment of the Dorsal Spanning Bridge Plate in Distal Radius Fracture Fixation: Implications for Immediate Weight-Bearing , 2018, Hand.

[23]  M. Trzeciak,et al.  Radiographic Outcomes of Dorsal Distraction Distal Radius Plating for Fractures With Dorsal Marginal Impaction , 2018, Hand.

[24]  A. Ilyas,et al.  Distal Radius Fractures in a Functional Quadruped: Spanning Bridge Plate Fixation of the Wrist. , 2018, Hand clinics.

[25]  Mohit J. Jain,et al.  A Comprehensive Study of Internal Distraction Plating, an Alternative Method for Distal Radius Fractures. , 2016, Journal of clinical and diagnostic research : JCDR.

[26]  H. Boateng,et al.  Distal Radius Fractures: Dorsal Bridge Plating , 2015 .

[27]  S. Koskinen,et al.  Radiographical measurements for distal intra-articular fractures of the radius using plain radiographs and cone beam computed tomography images , 2015, Skeletal Radiology.

[28]  S. Agnew,et al.  Functional Outcomes Following Bridge Plate Fixation for Distal Radius Fractures. , 2015, The Journal of hand surgery.

[29]  J. Elfar,et al.  Dorsal distraction plating for highly comminuted distal radius fractures. , 2015, The Journal of hand surgery.

[30]  D. Ring,et al.  The influence of dominant limb involvement on DASH and QuickDASH , 2015, Hand.

[31]  Tae Seob Kim,et al.  A Study on the Measurement of Wrist Motion Range Using the iPhone 4 Gyroscope Application , 2014, Annals of plastic surgery.

[32]  D. Ruch,et al.  Salvage of distal radius nonunion with a dorsal spanning distraction plate. , 2014, The Journal of hand surgery.

[33]  S. D. Dodds,et al.  Dorsal Spanning Plate Fixation for Distal Radius Fractures , 2013, Techniques in hand & upper extremity surgery.

[34]  C. Goldfarb,et al.  Dorsal locked plate fixation of distal radius fractures. , 2013, The Journal of hand surgery.

[35]  V. Neuhaus,et al.  Factors associated with incomplete DASH questionnaires , 2013, Hand.

[36]  Cindy S Tofthagen.  Threats to Validity in Retrospective Studies , 2012, Journal of the advanced practitioner in oncology.

[37]  D. Ruch,et al.  Distraction plating for the treatment of highly comminuted distal radius fractures in elderly patients. , 2012, The Journal of hand surgery.

[38]  D. Hanel,et al.  Complications associated with distraction plate fixation of wrist fractures. , 2010, Hand clinics.

[39]  L. Audigé,et al.  Comparison of functional outcome after volar plate fixation with 2.4-mm titanium versus 3.5-mm stainless-steel plate for extra-articular fracture of distal radius. , 2010, The Journal of hand surgery.

[40]  M. Melloh,et al.  A modified QuickDASH-9 provides a valid outcome instrument for upper limb function , 2009, BMC musculoskeletal disorders.

[41]  D. Moher,et al.  Preferred reporting items for systematic reviews and meta-analyses: the PRISMA Statement , 2009, BMJ : British Medical Journal.

[42]  D. Forward,et al.  Do young patients with malunited fractures of the distal radius inevitably develop symptomatic post-traumatic osteoarthritis? , 2008, The Journal of bone and joint surgery. British volume.

[43]  T. Trumble,et al.  A biomechanic comparison of an internal radiocarpal-spanning 2.4-mm locking plate and external fixation in a model of distal radius fractures. , 2006, The Journal of hand surgery.

[44]  D. Ruch,et al.  Use of a distraction plate for distal radial fractures with metaphyseal and diaphyseal comminution. Surgical technique. , 2006, The Journal of bone and joint surgery. American volume.

[45]  D. Hanel,et al.  Bridge Plating of Distal Radius Fractures: The Harborview Method , 2006, Clinical orthopaedics and related research.

[46]  British Society for Surgery of the Hand , 2006 .

[47]  I. Atroshi,et al.  Wrist-bridging versus non-bridging external fixation for displaced distal radius fractures: A randomized assessor-blind clinical trial of 38 patients followed for 1 year , 2006, Acta orthopaedica.

[48]  D. Ruch,et al.  Use of a distraction plate for distal radial fractures with metaphyseal and diaphyseal comminution. , 2005, The Journal of bone and joint surgery. American volume.

[49]  D. Ruch,et al.  Internal distraction plating of distal radius fractures. , 2005, Techniques in hand & upper extremity surgery.

[50]  K. Slim,et al.  Methodological index for non‐randomized studies (MINORS): development and validation of a new instrument , 2003, ANZ journal of surgery.

[51]  P. Wiemer,et al.  The operative therapy of distal unstable radius fractures with dorsal and volar plates. A retrospective study with respect to the DASH-score system , 1999, Der Orthopäde.

[52]  R. Singer,et al.  Treatment of comminuted distal radius with the use of an internal distraction plate. , 1998, Techniques in hand & upper extremity surgery.

[53]  L. Gilula,et al.  Displaced Intra-Articular Fractures of the Distal Aspect of the Radius. Long-Term Results in Young Adults after Open Reduction and Internal Fixation* , 1997, The Journal of bone and joint surgery. American volume.

[54]  Retraction Kiehntopf,et al.  Retraction , 1997, Concurr. Comput. Pract. Exp..

[55]  R. Sanders,et al.  External fixation of distal radial fractures: results and complications. , 1991, The Journal of hand surgery.

[56]  A. Ilyas,et al.  Bridge Plate Fixation of Distal Radius Fractures: Indications, Techniques, and Outcomes. , 2021, Orthopedics.

[57]  J. Jupiter,et al.  Current Perspectives on Complex Wrist Fracture-Dislocations. , 2018 .

[58]  C. Steiger,et al.  Treatment of highly comminuted distal radius fractures with temporary distraction plate , 2017 .

[59]  D. Hanel,et al.  Complex distal radius fractures. , 2013, The Orthopedic clinics of North America.

[60]  D. Dennison.  Use of a Distraction Plate for Distal Radial Fractures with Metaphyseal and Diaphyseal Comminution: Surgical Technique , 2007 .

[61]  D. Ruch,et al.  Volar versus dorsal plating in the management of intra-articular distal radius fractures. , 2006, The Journal of hand surgery.

[62]  John T Anderson,et al.  Complications of treating distal radius fractures with external fixation: a community experience. , 2004, The Iowa orthopaedic journal.

[63]  T. Gausepohl,et al.  External fixation of the wrist. , 1996, Injury.