This 2005 JAAOS review by Nana, Joshi, and Lichtman organizes distal radius plating using a three-column anatomic framework. It answers which plate belongs where and why, covering extra-articular fractures through complex intra-articular patterns. The three columns — lateral (radial styloid), dorsal medial, and volar medial — map directly to Melone's fracture components and drive every plate selection decision.
In 2005, dorsal plating was widely used for complex distal radius fractures, but the complication burden was underappreciated. This review crystallized the problem: up to 30% of dorsal plates require removal, and the locking pi plate yields only 57% good-to-excellent results.
When you see a dorsally displaced distal radius fracture with opposite-cortex comminution, a volar locking plate is the most reliable construct. Fixed-angle locking pegs support subchondral bone independent of far-cortex integrity, eliminating supplemental bone void filler or external fixation in most cases.
When you encounter a volar or dorsal Barton fracture (vertical shear pattern), a buttress plate is the correct choice — it is the only plate that actively reduces the fragment rather than holding what you have already reduced.
An ulnar styloid base fracture with more than 2 mm of displacement should prompt clinical DRUJ stability testing after the radius is stabilized, with fixation if instability is confirmed.
This 2005 JAAOS review by Nana, Joshi, and Lichtman organizes distal radius plating using a three-column anatomic framework. It answers which plate belongs where and why, covering extra-articular fractures through complex intra-articular patterns. The three columns — lateral (radial styloid), dorsal medial, and volar medial — map directly to Melone's fracture components and drive every plate selection decision.
In 2005, dorsal plating was widely used for complex distal radius fractures, but the complication burden was underappreciated. This review crystallized the problem: up to 30% of dorsal plates require removal, and the locking pi plate yields only 57% good-to-excellent results.
When you see a dorsally displaced distal radius fracture with opposite-cortex comminution, a volar locking plate is the most reliable construct. Fixed-angle locking pegs support subchondral bone independent of far-cortex integrity, eliminating supplemental bone void filler or external fixation in most cases.
When you encounter a volar or dorsal Barton fracture (vertical shear pattern), a buttress plate is the correct choice — it is the only plate that actively reduces the fragment rather than holding what you have already reduced.
An ulnar styloid base fracture with more than 2 mm of displacement should prompt clinical DRUJ stability testing after the radius is stabilized, with fixation if instability is confirmed.