Dorsal plating for displaced intra-articular fractures of the distal radius.

Thirty patients with a mean age of 42 years and a dorsally displaced intra-articular fracture of the distal radius were treated by dorsal plating (Forte, PI and AO T plates). Twenty-eight required autogenous iliac crest bone graft. Mobilisation was started at 1-2 weeks and patients were left free by 6-8 weeks. At a minimum of 6 months (mean 11 months) functional outcomes were excellent or good in 93% according to the Gartland and Werley score and 60% according to Green and O'Briens modified score. The mean time taken to return to work was 10 weeks. At the final follow-up, three patients had intra-articular steps, two of <1mm and one of <2mm. Four patients had five major complications. One extensor tendon rupture, one reflex sympathetic dystrophy (RSD), one significant radial shortening requiring a Darrachs' procedure, one painful and incongruent distal radio-ulna joint (DRUJ) also requiring a Darrachs' and one early subluxation of the DRUJ requiring re-operation. Eleven patients had plates removed. The indications for this was either irritation of extensor tendons, restriction of movement, as part of the treatment of one of the above complications or as part of the initial treatment protocol. In these high energy injuries in the younger age group there exists no ideal solution. Internal fixation allows more predictable restoration of anatomy and early return to function.