The presented double plating technique, with the radial plate used as a buttress plate, is a very useful tool to reduce a displaced radial styloid fragment in the frontal plane, particularly in osteoporotic bone or if the styloid fracture is multifragmentary. In these cases, anatomic reduction without the support of the radial plate can be difficult. Secondary dislocation did not occur in any of our patients. Biomechanical data for this fixation are not available, but it seems that sufficient stability was present to allow a functional rehabilitation protocol, even in osteoporotic fractures. The mechanical strength of this double-plating technique is mainly provided by the volar plate, whereas the radial plate acts as a buttress plate holding the radial styloid fragments in place. In general, only 1-2 proximal screws were used on the radial plate for this purpose.
In the present study, flexion and extension fractures are included, but they are two separate entities. However, the tendency for radial dislocation can be a common factor in both fracture types, and the radial plate can be helpful in both types.
Functional outcome for our study population reflects what is reported in the literature for distal radius fractures (although less difficult fractures were involved in most reports) [3, 6, 10, 21]. In the follow-up, the radial plate can cause some irritation to the first extensor compartment, which is why metal removal was done in five cases. In our series, standard plates were used as the radial plate. A specially designed radial buttress plate might reduce tendon irritation. In our country, the barrier to metal removal is low, and many patients request it due to minimal symptoms. However the possibility of removal of the radial plate should be considered before wound closure in selected cases with a sufficiently stabilized radial styloid process. This is favoured if the radial styloid process fragment is not a multifragmentary fracture or osteoporotic.
The surgical approach is important. Most surgeons utilise the Henry approach to the volar side of the distal radius, entering between the flexor carpi radialis tendon and the radial artery . This approach has been modified by Orbay to include release of the distal osseous insertion of the brachioradialis tendon . This permits better manipulation of the fracture fragments because the brachioradialis tendon is known to be an important deforming force in such injuries .
If visual control of the articular surface during reduction is necessary, a single volar approach is contraindicated unless sufficient control of the articular surface can be provided by arthroscopy . This can be the case in joint depression fractures, in fractures with completely displaced joint fragments or in fractures of the dorsal rim. These fractures are therefore also inappropriate for the described technique. In the present study, polyaxial locking plates were exclusively used. The technique is also suitable for uniaxial plates. This may be an advantage for stability, but is disadvantageous for optimal placement of screws.
The present study had limitations. First, radiographic evaluations were done on standard X-rays, and only in 6 of 10 cases was an initial CT available. Second, the study population was relatively small because the number of patients reflected only about 10% of the radius fractures treated surgically at our hospital. Third, a follow-up period of two years is too short to draw definitive conclusions on osteoarthritic development.