Is Dorsal Vertical Double Plating an Effective Alternative to Volar Plating for Distal Radius Fractures With Dorsal Collapse?

TL;DR

This study finds that dorsal vertical double plating is as effective as volar plating for treating complex wrist fractures, with no tendon ruptures when using careful techniques.

Contribution

The study demonstrates that DVDP is a viable alternative to VLP for dorsally collapsed distal radius fractures with no tendon ruptures.

Findings

DVDP and VLP showed comparable radiographic and functional outcomes at 12 months.

Complication rates were similar, with no tendon ruptures in the DVDP group.

DVDP can be a biomechanically effective alternative with proper surgical techniques.

Abstract

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.

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 χ
2 test.

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.

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.

Dorsal vertical double plating shows equivalent functional outcomes to volar plating in dorsally collapsed distal radius fractures. With compartment‐sparing dissection and low‐profile implants, this approach achieved zero tendon ruptures, establishing its viability as a biomechanically effective alternative.

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