Open reduction and internal fixation of distal radius extension fractures in women over 60 years of age with the dorsal radius plate (π-plate)

Purpose: The goal of this study was to review the clinical and radiological results and to correlate them with the functional outcome score DASH in women over 60 years who underwent open reduction and internal fixation with a pi-plate for displaced distal radius fractures. Method and Clinical Material: In this retrospective study, forty-nine women over 60 years old with mainly intra-articular distal radius fractures underwent open reduction and internal fixation with a pi-plate. The dorsal approach was used permitting an anatomical reduction of the articular surface under direct vision of the radio-carpal joint. Patient follow-up was for a minimum of twelve months with a mean of 32 months. Results: For 71% of patients, there were no limitations in their daily activities and only one patient complained of a major disability. Overall, the flexion of the wrist was reduced by 15 degrees compared to the opposite side (mean 50 degrees). The DASH score (14.4) was not higher than that of a comparable age controlled group without radius fracture. The pi-plate was demonstrated to be a stable implant in osteoporotic bone and there was only one secondary dislocation. Most patients were painfree with two patients describing tolerable pain, one because of a progressing radio-carpal osteoarthritis and the second due to a neuroma of the superficial branch of the radial nerve. The other major complication was a late rupture of the extensor tendon of the index finger in one of the twelve patients where the pi-plate had not been removed. Conclusion: We recommend anatomical reduction and internal fixation for displaced intra-articular distal radius fractures using a dorsal approach to achieve a good wrist function including painless load bearing with the implant removed four months after surgery.