Outcomes of Dorsal Bridging Plates
Fares, A. B., Childs, B. R., Polmear, M. M., Clark, D. M., Nesti, L. J., & Dunn, J. C. (2021). Dorsal Bridge Plate for Distal Radius Fractures: A Systematic Review. The Journal of Hand Surgery. https://doi-org.methodistlibrary.idm.oclc.org/10.1016/j.jhsa.2020.11.026
Distal radius fractures (DRF) are a common injury that we see in the hand therapy field. Most often, DRFs are treated with an ORIF volar plate or even a volar spanning plate. However, with more significant DRFs, it is common to see dorsal bridging/spanning plates for internal fixation. However, this method prevents flexion/extension and radial/ulnar deviation of the wrist for an extended period of time. This systematic review identified the long-term outcomes for patients who had a dorsal bridging plate for DRFs.
In the Weeds
The authors identified a total of 206 articles and narrowed it down to 12 articles that met their inclusion criteria. The studies included were peer-reviewed, from the English language North American or European journal, participants must have had a dorsal bridging plate for a DRF, and the results must have stated outcome measures such as range of motion, strength, complications, and functional outcomes. Next, the studies were analyzed for outcomes and assessment results.
Bringing it Home
Overall, the most common fractures treated with a dorsal bridging plate had a comminuted or intraarticular fracture and were from a polytrauma accident. The mean timeframe for DBP placement to removal was an average of 119 days. After hardware removal, at the final visit, the average wrist flexion was 45 degrees, the average wrist extension was 50 degrees, pronation was at 75 degrees, and supination was at 73 degrees. The mean DASH score was 26.1 and the mean QuickDASH score was 19.8. Complications for the DBP were 13%, varying from hardware failure, symptomatic malunion, and persistent pain. About a 10-degree extension lag was present in 12% of participants and persistent pain was found in 9% of participants.
From the study results, patients with a DBP demonstrated an average flexion and extension arc of 95 degrees, displaying a functional ROM for completion of ADLs. Most patients demonstrated functional ROM about three months after dorsal spanning plate removal. The authors also identified little evidence to support the notion of prolonged fixation leading to notable loss of range of motion. Regarding infection rates, the DBP and the volar locking plate (VLP) had a 3% inflection rate for deep and superficial infection. In contrast, fractures treated with external fixation had a superficial infection rate of 21%.
The review provided accurate insight into long-term outcomes of distal radius fractures fixated with dorsal blocking plates. Some limitations include a small sample size within most studies, the variation of injuries related to polytraumas, and limited knowledge of patient outcomes beyond 1 year post-accident, such as the possibility of posttraumatic osteoarthritis. However, the review concluded that most studies provided similar outcomes regarding wrist ROM, fracture type, and complications suggesting reliable and valid evidence produced by the studies included in the review.
Dy, C. J., Wolfe, S. W., Jupiter, J. B., Blazar, P. E., Ruch, D. S., & Hanel, D. P. (2014). Distal radius fractures: strategic alternatives to volar plate fixation. Instructional Course Lectures, 63, 27–37.
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