Open reduction and plate fixation of displaced AO type C3 fractures of thedistal radius: Restoration of articular congruity in eighteen cases

Objective: To determine the ability of open reduction and plate fixation to restore articular congruity in the treatment of fractures of the distal ra dius with intraarticular comminution and displacement. Design: Prospectively followed series. Methods: Eighteen consecutive fractures of the distal radius with intraarti cular comminution and displacement were treated with open reduction and com bined volar and dorsal plate fixation in thirteen, dorsal plate fixation in four, and volar plate fixation in one case. Kirschner wiles were added in thirteen fractures and cancellous bone graft was used in four fractures. Ar ticular congruity after a mean follow-up of twenty-three months was assesse d using anteroposterior and lateral radiographs. Results: Articular congruity without a two millimeter or more intraarticula r stepoff was found at follow-up in fifteen of eighteen cases, without a tw o millimeter or more gap in nine cases and without a two millimeter or more stepoff or gap in only right cases. One reason for not having obtained art icular congruity in some of the fractures was insufficient intraoperative v isualization of the joint surface, Three reduced fractures redisplaced, The reason for loss of intraarticular reduction was considered insufficient st abilization of the distal fragments. In two of the three cases, it was thou ght that insertion of bone graft would have prevented the loss of reduction , Conclusions: Articular incongruity after open reduction and plate fixation of comminuted fractures of the distal radius may occur more often than expe cted. The reduced fracture should be evaluated by intraoperative radiograph s. If the reduced joint surface is not entirely visible on the radiographs because of implants of other reasons, oblique radiographs or fluoroscopy sh ould be additionally used. Plate fixation alone does not always provide suf ficient stability and cancellous bone graft should be added in cases of met aphyseal bone loss or for stabilization of multiple small articular fragmen ts that cannot be fixed by screws ol Kirschner wires.