Internal fixation of distal radius fractures with dorsal dislocation: pi-plate or two 1/4 tube plates? A prospective randomized study

Background: Severely comminuted distal radius fractures can be treated by d ifferent methods, Our routine procedure in dorsal dislocated fractures is t he dorsal stabilization with two 1/4 tube plates. The new pi-plate is an ot her device that matches optimally the anatomy of the distal radius and allo ws a near half-circumferential dorsal buttress of comminuted intraarticular and extra-articular radial fractures, Methods: In a prospective randomized study, comminuted distal radius fractu res with dorsal displacement were stabilized either with two 1/4 tube plate s or with the pi-plate. All patients were reviewed at 1, 3, and 6 months af ter surgery by thorough clinical examination and standard radiographs of bo th wrists, Results were analyzed and compared in both groups. Results: Subjective and objective results in the pi-plate group are disappo inting. Although optimal anatomic results were achieved, the complication-r ate was high (14.3%) and the range of motion was limited, At final review, extension and flexion of the injured wrist had recovered to an average of 6 7% of the normal, contralateral side. Radial and ulnar deviation mere limit ed to 64%, whereas pronation and supination reached 89% and 87% respectivel y. Overall, results were good to excellent only in 56%. In a comparable gro up of patients with similar fractures and stabilization with two 1/4 tube p lates, 82% of patients achieved excellent to good results, wrist motion was significantly better (p < 0.05), and no complications occurred, Conclusion: With open reduction, cancellous bone grafting, and internal pla te fixation in comminuted distal radial fractures, excellent results can be achieved. In our experience, we cannot recommend the pi-plate in its curre nt shape and prefer to stabilize distal radius fractures and dorsal fragmen t dislocations with two 1/4 tube plates.