Dorsal bridge plating, volar plating, or both? A retrospective analysis of clinical and radiographic outcomes of intraarticular distal radius fracture fixation techniques.

Abstract

Optimal fixation for complex AO/OTA 2R3C intraarticular distal radius fractures remains debated, particularly the role of dorsal bridge plating (DBP) alone or in combination with volar plating (VP). This study compared radiographic outcomes and complications across VP, DBP, and combined VP-DBP constructs. A retrospective cohort study was conducted at a single Level I trauma center (2020-2024). Adults with AO/OTA 2R3C distal radius fractures treated with VP alone, DBP alone, or combined VP-DBP and with ≥ 6 months of follow-up were included. Standard radiographic parameters (volar tilt [VT], radial height [RH], radial inclination [RI], and ulnar variance [UV]) were measured immediately postoperatively and at final follow-up. Wrist range of motion (flexion, extension, pronation, supination) at final follow-up was recorded from clinic documentation. Complications included fracture-related infection (FRI), reoperation to promote bone healing, hardware removal (HWR), and unplanned reoperation. Group comparisons used one-way ANOVA and chi-square/Fisher's exact tests. A total of 153 patients (mean age: 50 years) were included; 84 (54.9%) underwent VP, 44 (28.8%) DBP, and 25 (16.3%) combined fixation. Immediately postoperatively, DBP achieved greater RI (22.3° versus 19.7° VP versus 18.9° combined) and RH (13.4 mm versus 11.6 mm versus 11.3 mm), while VT was greatest with VP (9.9° versus 8.3° DBP versus 4.5° combined; all p < 0.05). At final follow-up, UV, VT, RI, and RH did not differ significantly between constructs, although all groups demonstrated increased UV over time, greatest in the combined cohort. FRI (0-3.6%) and unplanned reoperation (7.8% overall) rates were similar across groups. HWR was more frequent after DBP and combined fixation, reflecting planned implant removal. At final follow-up, VP demonstrated greater wrist flexion and extension compared with DBP and combined fixation (p < 0.05), while pronation and supination were similar between groups. Across fixation strategies for intraarticular distal radius fractures, no single construct demonstrated radiographic superiority at final follow-up, although volar plating was associated with greater flexion and extension at final follow-up. These findings underscore the importance of tailoring fixation strategy to fracture pattern and patient-specific factors when managing complex distal radius fractures.