Wrist-spanning dorsal bridge plates helps elderly use walker after distal radius fractures: Study
Recent research published in the Journal of Hand Surgery has revealed that elderly, walker-dependent patients may be able to use their walker as tolerated immediately after dorsal bridge plate fixation for extra-articular fractures.
The fixation of comminuted distal radius fractures using wrist-spanning dorsal bridge plates has been shown to have good postoperative results.
Hence, the team of researchers headed by Jeremy E. Raducha from the Department of Orthopaedics, Warren Alpert Medical School of Brown University, Providence, RI carried out the present study to hypothesize that using a stiffer bridge plate construct results in less fracture deformation with loads required for immediate crutch weight bearing.
The authors created a comminuted, extra-articular fracture in 7 cadaveric radii, which were fixed using dorsal bridge plates. The specimens were positioned to simulate crutch/walker weight bearing and axially loaded to failure.
The axial load and mode of failure were measured using 2- and 5-mm osteotomy deformations as cutoffs. Bearing 50% and 22% of the body weight was representative of the force transmitted through crutch and walker weight bearing, respectively.
The results showed that-
- The load to failure at 2-mm deformation was greater than 22% body weight for 2 of 7 specimens and greater than 50% for 1 of 7 specimens.
- The load to failure at 5-mm deformation was greater than 22% body weight for 6 of 7 specimens and greater than 50% for 4 of 7 specimens.
- The mean load to failure at 2-mm gap deformation was significantly lower than 50% body weight (110.4 N vs 339.2 N).
- The mean load to failure at 5-mm deformation was significantly greater than 22% body weight (351.8 N vs 149.2 N).
- All constructs ultimately failed through plate bending.
Hence, the authors concluded that "all constructs failed by plate bending at forces not significantly greater than the 50% body weight force required for full crutch weight bearing. The bridge plates supported forces significantly greater than the 22% body weight required for walker weight bearing 6 of 7 times when 5 mm of deformation was used as the failure cutoff."
They further inferred that elderly, walker-dependent patients may be able to use their walker as tolerated immediately after dorsal bridge plate fixation for extra-articular fractures. However, patients should not be allowed to bear full weight using crutches immediately after bridge plating.
