An Assessment of Distraction Plating in the Management of Intra-Articular Comminuted Distal End Radius Fractures in the Elderly

Abstract Background: Distal radius fractures are one of the most common injuries, representing one-sixth of all fractures seen and treated in the emergency department. Distal radial fractures with extensive comminution involving the metaphyseal–diaphyseal junction present a major treatment dilemma, especially when it has an intra-articular involvement. This study evaluates the surgical and functional outcomes of intra-articular comminuted fracture of distal end radius treated with dorsal distraction plating. Materials and Methods: A prospective randomized controlled observational study was done with a sample size of 50 patients over a period of 3 years, each of whom was diagnosed to have an intra-articular fracture of distal end radius (AO classification type C). All patients were treated by distraction plating (radio-metacarpal). Minimum follow-up after treatment of upto 6 months was ensured, and a final assessment of the functional outcome was then decided. Results: The study showed that average union time was 8.65 ± 0.93 weeks, and average implant removal was done at 8.75 ± 0.85 weeks. All patients achieved full ROM at the wrist, maintaining articular congruity post-implant removal. In our study, we found two (6.67%) patients with superficial infections and two (6.67%) patients with complex regional pain syndrome. No patients were reported with the tendon (extensor pollicis longus) irritation, neuropraxia, stiffness of the wrist and inter-phalangeal joints, nonunion/malunion, or implant failure. Conclusion: The final results were evaluated and compared after making observations for age, sex, mode of trauma, dominancy of the affected hand, time interval between injury and admission, duration of hospital stay, duration of surgery, time to fracture union, and complications. The final outcome was measured by DASH SCORE. All patients had excellent or good results treated with distraction plating; six (20.00%) patients out of 30 studies were found to have excellent results, whereas the remaining 24 (80.00%) patients had good results.