Objective: Dorsal articular collapse in distal radius fractures presents unique fixation challenges. While volar locking plating (VLP) dominates current practice, dorsal vertical double plating (DVDP) offers direct biomechanical support but carries perceived tendon risks. This study compares DVDP versus VLP for dorsally collapsed comminuted fractures.
Methods: A retrospective cohort of 106 patients (2022–2024) with AO type C2/C3 fractures received either VLP (n = 50) or DVDP (n = 56). General information encompassed gender, age, injured side, injury mechanism, AO classification, time from injury to surgery, operative time and complication profiles. Primary outcomes included 12-month radiographic parameters (volar tilt, ulnar inclination, and radial height), wrist range of motion (ROM), functional scores (DASH, Gartland-Werley), and complications. Continuous variables were compared using the Mann–Whitney U test. Categorical variables were analyzed with Pearson's χ2 test.
Results: The study cohort comprised 106 patients with dorsally collapsed distal radius fractures (VLP = 50, DVDP = 56). Baseline characteristics, including age (VLP median 59 years [IQR: 55–61.25] vs. DVDP 57 [53–61]), gender distribution (36% vs. 35.7% male), injury mechanism (72% vs. 71.4% falls), and AO classification (C3: 76% vs. 76.8%), showed no significant differences (all p > 0.05). At 12-month follow-up, all fractures achieved union with comparable radiographic outcomes: volar tilt (10° [8°–12°] vs. 10° [9°–12°]), ulnar inclination (22° [20°–23°] vs. 23° [22°–23°]), and radial height (11 mm [9–12] vs. 11 mm [10–12]) (all p > 0.05). Functional assessments revealed equivalent ranges of motion: dorsiflexion (69.5° [62°–76°] vs. 70° [68°–75°]), palmar flexion (68° [60°–70°] vs. 69.5° [66°–70°]), and rotation (pronation-supination: 80° [67.75°–65°]/71.5° [61.5°–81.25°] vs. 75.5° [70°–82°]/75° [68°–80°]). Patient-reported outcomes were similar: Gartland–Werley scores (5 [3–8] vs. 5 [3–7.75]) and DASH scores (12.5 [10–15.42] vs. 12.5 [12.5–15]) (all p > 0.05). Complication rates were comparable (VLP: 10% transient median neuropathy vs. DVDP: 12.5% tendon adhesions, p = 0.69), with all cases resolving conservatively within 3 months. Crucially, the DVDP group demonstrated zero tendon ruptures using tendon-sparing techniques.
Conclusion: DVDP demonstrates non-inferior functional and radiographic outcomes to VLP for dorsally collapsed fractures. With meticulous technique—including intercompartmental approaches and low-profile implants—DVDP eliminates historical tendon risks and serves as a viable surgical alternative.
| [1] |
S. Meena, P. Sharma, A. K. Sambharia, and A. Dawar, “Fractures of Distal Radius: An Overview,” Journal of Family Medicine and Primary Care 3 (2014): 325–332, https://doi.org/10.4103/2249-4863.148101.
|
| [2] |
K. Lutsky, M. Boyer, and C. Goldfarb, “Dorsal Locked Plate Fixation of Distal Radius Fractures,” Journal of Hand Surgery 38 (2013): 1414–1422, https://doi.org/10.1016/j.jhsa.2013.04.019.
|
| [3] |
R. Gajdos, M. Bozik, and P. Stranak, “Is an Implant Removal After Dorsal Plating of Distal Radius Fracture Always Needed?,” Bratislavské Lekárske Listy 116 (2015): 357–362, https://doi.org/10.4149/bll_2015_068.
|
| [4] |
O. Ayalon and N. Paksima, “Dorsal Plating of Distal Radius Fractures Historical Context and Appropriate Use,” Bulletin of the Hospital for Joint Diseases 75 (2017): 4–8.
|
| [5] |
Y. Abe, S. Tokunaga, and T. Moriya, “Management of Intra-Articular Distal Radius Fractures: Volar or Dorsal Locking Plate-Which Has Fewer Complications?,” Hand (N Y) 12 (2017): 561–567, https://doi.org/10.1177/1558944716675129.
|
| [6] |
E. Kaya and T. Keçeci, “Extra-Articular Coronal Protrusion of Volar Locking Plate and Screw Cutout in the Treatment of Distal Radius Fracture in Coronal Plane: Classification, Clinical Outcomes and How to Prevent,” Journal of Orthopaedic Science 30, no. 5 (2025): 816–823, https://doi.org/10.1016/j.jos.2025.04.013.
|
| [7] |
N. A. Hoekzema and M. Brambila, “Column-Specific Distal Radius Fracture Fixation,” Journal of Orthopaedic Trauma 35 (2021): s17–s20, https://doi.org/10.1097/BOT.0000000000002203.
|
| [8] |
H. S. Jung, H. C. Cho, and J. S. Lee, “Combined Approach for Intra-Articular Distal Radius Fracture: A Case Series and Literature Review,” Clinics in Orthopedic Surgery 13 (2021): 529–538, https://doi.org/10.4055/cios20291.
|
| [9] |
B. Kibar, “Combined Palmar and Dorsal Plating of Four-Part Distal Radius Fractures: Our Clinical and Radiological Results,” Joint Diseases and Related Surgery 32 (2021): 59–66, https://doi.org/10.5606/ehc.2021.75599.
|
| [10] |
J. J. Gartland and C. W. Werley, “Evaluation of Healed Colles' Fractures,” Journal of Bone and Joint Surgery, American Volume 33-A (1951): 895–907.
|
| [11] |
P. L. Hudak, P. C. Amadio, and C. Bombardier, “Development of an Upper Extremity Outcome Measure: The DASH (Disabilities of the Arm, Shoulder and Hand) [Corrected]. The Upper Extremity Collaborative Group (UECG),” American Journal of Industrial Medicine 29 (1996): 602–608, https://doi.org/10.1002/(SICI)1097-0274(199606)29:6<602::AID-AJIM4>3.0.CO;2-L.
|
| [12] |
L. E. Schindelar and A. M. Ilyas, “Plate Fixation of Distal Radius Fractures: What Type of Plate to Use and When?,” Hand Clinics 37 (2021): 259–266, https://doi.org/10.1016/j.hcl.2021.02.008.
|
| [13] |
M. Yamamoto, Y. Fujihara, N. Fujihara, and H. Hirata, “A Systematic Review of Volar Locking Plate Removal After Distal Radius Fracture,” Injury 48 (2017): 2650–2656, https://doi.org/10.1016/j.injury.2017.10.010.
|
| [14] |
S. Perregaard, R. W. Jorgensen, and M. Landgren, “Complications After Volar Locking Plate Fixation of Distal Radius Fractures: A Retrospective Study of 822 Patients,” Journal of Hand Surgery 49 (2024): 745–750, https://doi.org/10.1016/j.jhsa.2022.11.012.
|
| [15] |
C. L. E. Laane, A. L. Dijkmans, C. J. Messinger, M. M. E. Wijffels, A. R. Bhashyam, and N. C. Chen, “Cause of Extensor Pollicis Longus Ruptures After Distal Radius Fracture Fixation Using a Volar Plate,” Hand (N Y) 20, no. 5 (2025): 770–777, https://doi.org/10.1177/15589447241233763.
|
| [16] |
N. K. Masjedshahi, F. N. Mazhar, N. S. Mohammadi, R. Mohammadi, M. J. Kafiabadi, and H. Shariatzade, “The Longest Postoperative Time of Flexor Pollicis Longus Tendon Rupture, 15 Years After Volar Locking Plate Fixation of a Distal Radius Fracture: A Case Report,” International Journal of Surgery Case Reports 130 (2025): 111321, https://doi.org/10.1016/j.ijscr.2025.111321.
|
| [17] |
J. H. Lee, J. T. Ahn, and J. H. Baek, “Dorsal Plating Versus Volar Plating With Limited Dorsal Open Reduction in the Management of AO Type C3 Distal Radius Fractures With Impacted Articular Fragments: A Retrospective Comparative Study,” Acta Orthopaedica et Traumatologica Turcica 56 (2022): 42–47, https://doi.org/10.5152/j.aott.2022.21157.
|
| [18] |
J. T. Labrum, D. A. Moreno, M. E. Davis, T. M. Yong, and W. T. Obremskey, “Dorsal Impaction Injuries of the Distal Radius: Operative Technique Through Dorsal Approach to the Wrist,” Journal of Orthopaedic Trauma 37 (2023): S1–S2, https://doi.org/10.1097/BOT.0000000000002631.
|
RIGHTS & PERMISSIONS
2025 The Author(s). Orthopaedic Surgery published by Tianjin Hospital and John Wiley & Sons Australia, Ltd.
PDF
