Combined Dorsal Spanning and Volar Plating for Management of Highly Comminuted Distal Radius Fractures.

Abstract

Comminuted intraarticular distal radius fractures remain a surgical challenge, with no consensus on the optimal fixation method. Conventional techniques such as volar plating or external fixation may be insufficient to restore anatomical alignment and articular congruity in highly comminuted cases. This study evaluated the clinical and radiographic outcomes of combined dorsal spanning plate (DSP) and volar locking plate (VLP) fixation for management of comminuted distal radius fractures. This prospective cohort study was conducted at a level I university trauma center between 2018 and 2024. Skeletally mature patients with comminuted distal radius fractures (AO/OTA 23-C2, or 23-C3) were included, while open fractures, pathological fractures, malunions, and cases with neurovascular injury were excluded. All patients underwent fixation with a combined technique: initial distraction and stabilization using a DSP followed by volar buttressing with a VLP. Functional outcomes were assessed using the Disabilities of the Arm, Shoulder and Hand (DASH) score and the Patient-Rated Wrist Evaluation (PRWE) score, whereas radiographic assessment focused on fracture union and alignment. A total of 23 patients (mean age 34.3 years; 69.6% male) were included, with a mean follow-up of 30.8 months. All fractures achieved radiographic union with restoration of volar tilt, radial inclination, and ulnar variance. At the final follow-up, the mean DASH score was 14.5 ± 11.7, and the mean PRWE score was 17.9 ± 13.8, reflecting favorable functional recovery. Combined DSP and VLP provides stable fixation, maintains articular congruity, and allows early rehabilitation in complex comminuted distal radius fractures, with favorable functional outcomes.