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1. MANAGEMENT OF DORSALLY DISPLACED
INTRAARTICULAR FRACTURE OF THE
DISTAL RADIUS WITH DORSAL LOCKING
PLATE
PRESENTER: DR PRAVIN TODEKAR 3RD
YEAR PGT
PROF SANJIB WAIKHOM
HOD DEPT OF ORTHOPAEDICS
RIMS, IMPHAL

2. Distal radius fractures account for 17% of all fractures treated by
orthopedic trauma surgeons, with 60% being intra-articular and unstable.
The primary goal of treatment is precise reduction and stable fixation.
Treatment options include casting, percutaneous pinning, ligamentotaxis
and open reduction and fixation with volar or dorsal plating.
INTRODUCTION

3. • VLP recently gained popularity as the primary option for treatment of DER fractures,
but in cases like
a. Dorsally displaced fractures having significant dorsal die punch fragment.
b. Volar fracture line is distal to the watershed line or associated with dorsally
comminuted fractures
• In these situations ulnar corner fragment cannot be held by VLP or the distal edge of
VLP can impinge on flexor tendons and cause injury.

4. • Advantages of dorsal plating
a. Direct visualization of articular surface.
b. Provides a buttress against dorsal collapse.
c. Lowers the risk of neurovascular structure damage.
• Dorsal plate has higher incidence of tendon complications but the newer
generation low profile plates overcome these complications.

5. OBJECTIVES
To assess the functional and radiological outcomes of dorsally displaced
distal radius fractures treated with open reduction internal fixation (ORIF)
using 2.7 mm pi-plate.

6. Study place & duration
RIMS Imphal Manipur
April 2023 to January 2025
Study design
Prospective cohort study
Sample size
40
Study tools
Structured proforma
Plain X ray of the wrist
NCCT of wrist
Instruments for dorsal plating
Outcome measures
Modified green o Brien score
Q Dash score
METHODOLOGY

7. INCLUSION CRITERIA
Patients with radiologically
confirmed dorsally displaced
intra-articular fractures of the
distal radius
Medically fit
Willing for the procedure
Injuries not older than 2 weeks
Age group more than 18 years
EXCLUSION CRITERIA
Open fracture
Polytrauma patients
Previous fracture in the same
limb
Patient lost to follow up
 Non-cooperative patient
Bilateral fractures

8. AIM OF SURGERY
• To restore radiological
parameters
1. Radial height
2. Radial inclination
3. Palmar tilt
4. Ulnar variance
5. Articular step-off
• To restore functional status
1. Wrist flexion
2. Wrist extension
3. Supination
4. Pronation
5. Ulnar deviation
6. Radial deviation
7. Grip strength

9. PRE OPERATIVE X-RAY PRE OPERATIVE NCCT
Left Distal radius fracture with intra articular involvement and dorsal displacement

10. Dorsal straight skin
incision
Extensor retinaculum seen EPL identified and
retracted to radial side
INTRA OPERATIVE IMAGES

11. Subperiosteal elevation of
4th
and 2nd
extensor
compartment and fracture
site exposed
Dorsal plate (Pi plate) fixed
over fracture fragments
Retinaculum is closed and
EPL kept superficial to it
Sutured wound

12. Immediate Post op X ray

13. 6 months follow up
6 weeks follow up 12 weeks follow up

14. Wrist flexion Wrist extension
Supination Pronation
ROM at 6 months follow-up

15. Radial deviation Ulnar deviation

16. POSTOPERATIVE FOLLOW-UP
Rom exercise started on the 3rd
post-op day.
Patients were followed up on 12th
day, at 6 weeks, 12 weeks, 24 weeks and after
1 year.
Sutures removed on 12th
day.
During each visit radiographic parameters and functional outcome (Q DASH &
Modified green O’Brien score) were assessed.

17. RESULTS
DEMOGRAPHICS
This study included 40 patients
Aged between 20 to 50 years
Male to female ratio of 3:1
Mean duration of follow-up is 24 weeks, and mean fracture union time is 6
to 8 weeks
The most common mode of injury is RTA (56%) followed by FOOSH (28%)
followed by fall from height (12%), and others (4%).

18. COMPARISON OF RADIOLOGICAL PARAMETERS PRE & POST
OPERATIVELY

19. FOLLOW UP AFTER 6 MONTHS
Supination
Pronation
Wrist flexion
Wrist extension
Radial deviation
Ulnar deviation
0 10 20 30 40 50 60 70 80 90
ROM of Wrist
Column1 Series 1
75
80
70
72
18
28

20. The functional outcome of participants was assessed using Q DASH
score and Modified Green O’Briens score at various follow-up intervals
According to the Q DASH score 32 patients had an excellent outcome, 7
patients had a good outcome and 1 patient had a fair outcome.
According to Modified Green O’Briens score 29 patients had an excellent
outcome, 10 patients had good outcome and 1 patient had poor outcome.

21. COMPLICATIONS
There were no plate breakage, infections, tendon rupture, or
compression neuropathy during the study period
Tendon irritation was observed in one patient for which plate removal
was done after 6 months.

22. CONCLUSION
Dorsal locking plate is a useful technique for the treatment of selected
cases of dorsally displaced, comminuted intra-articular fractures of the
distal radius.
Tendon complications can be avoided by careful subperiosteal elevation
of 2nd
and 4th
compartment and avoiding direct contact of plate with a
tendon.

23. THANK YOU