Internal Fixation of Distal Radius Fractures with Dorsal Dislocation: ??-Plate or Two 1/4 Tube Plates? A Prospective Randomized Study

BACKGROUND: Severely comminuted distal radius fractures can be treated by different methods. Our routine procedure in dorsal dislocated fractures is the dorsal stabilization with two 1/4 tube plates. The new pi-plate is an other device that matches optimally the anatomy of the distal radius and allows a near half-circumferential dorsal buttress of comminuted intraarticular and extra-articular radial fractures. METHODS: In a prospective randomized study, comminuted distal radius fractures with dorsal displacement were stabilized either with two 1/4 tube plates or with the pi-plate. All patients were reviewed at 1, 3, and 6 months after surgery by thorough clinical examination and standard radiographs of both wrists. Results were analyzed and compared in both groups. RESULTS: Subjective and objective results in the pi-plate group are disappointing. Although optimal anatomic results were achieved, the complication-rate was high (14.3%) and the range of motion was limited. At final review, extension and flexion of the injured wrist had recovered to an average of 67% of the normal, contralateral side. Radial and ulnar deviation were limited to 64%, whereas pronation and supination reached 89% and 87%, respectively. Overall, results were good to excellent only in 56%. In a comparable group of patients with similar fractures and stabilization with two 1/4 tube plates, 82% of patients achieved excellent to good results, wrist motion was significantly better (p < 0.05), and no complications occurred. CONCLUSION: With open reduction, cancellous bone grafting, and internal plate fixation in comminuted distal radial fractures, excellent results can be achieved. In our experience, we cannot recommend the 7pi-plate in its current shape and prefer to stabilize distal radius fractures and dorsal fragment dislocations with two 1/4 tube plates.