Dorsally displaced distal radius fractures fixation: Dorsal versus volar plating. A randomized controlled study

Background: Distal radius fractures are one of the most common fractures of human skeleton accounting for one sixth of all fractures seen in emergency room. Close reduction and cast immobilization used to be the mainstay of treatment of the fractures of the distal radius. Best modality of achieving restoration of anatomy of wrist is by open reduction and internal fixation with plating. Significant controversies exist about whether dorsal or volar plating is superior for fixation of dorsally comminuted distal radial fractures. The aim of this study is to compare outcome of dorsally displaced fracture of distal end radius managed with Dorsal plating vs volar plating. Materials and methods: The study was conducted in Department of Orthopaedics, RIMS, and Ranchi from October 2016 to October 2017 (one year duration). Thirty skeletally mature patients of either sex (18 male and 12 female), presenting with dorsally displaced distal radius fracture, (AO type A and C) were selected for the study. The mean age of the patients was around 50 yrs. We conducted a prospective randomized study between a group of 16 patients treated with a dorsal plating (group 1) and a group of 14 patients managed with volar plating (group II). We analyzed both the clinical results (complications and functional evaluation) and the radiographic results from A/P and lateral radiographs in the early postoperative period and at 6 weeks, 3 months, 6 months follow up.Results: Volar plating had better range of wrist movement in all directions with significant difference in dorsiflexion, pronation and supination movement. As per Gartland and werley score, functional outcome in both groups increased post operatively with continued physiotherapy and rehabilitation. The differences were non-significant. Radiological determinants were volar angle, radial length and radial inclination. Results shows, marginal better maintenance of radiological parameters with dorsal plating then volar plating but the differences between two groups are statistically non- significant, {p>0.05}. Complications between two groups have no significant difference Incidence of neurological complication was more seen with volar plating, while dorsal plating associated with tendon irritation and hardware problemsConclusion: Both Dorsal plating and Volar plating are valid approach to fix dorsally displaced fracture distal end radius. As functional outcome in patients managed with volar plating is better than those managed with dorsal plating so, volar plating should be the approach of choice.