Minimal soft tissue disruption, adequate fixation and short period of immobilization helps in good fracture union and functional outcome.[1]
Closed reduction and external fixation acquires good amount of fracture alignment, metaphyseal angulation and radial height through ligamentotaxis. But it fails to reduce small comminuted fractures and dorsally rotated volar medial distal fragments. It might also lead to disuse osteoporosis and joint stiffness. Anatomical reduction of the articular surface is must to prevent joint stiffness and arthritis in future. Hence open reduction is necessary in such fractures.[1]
In literature, locking compression plates in management of distal end radius fractures have proved to be superior in providing adequate radial height, radial inclination and volar tilt, ensuring higher rigidity and anatomical stability as compared to other modes of treatment. Distal end radius fractures management demand anatomical reduction and restoration of joint surface with articular congruity to prevent post traumatic arthritis, weak hand grip and gain better functional outcome.[3]
The complex interaction between the radius and ulna determines the forearm rotation and the restoration of this movement depends on both an accurate reduction of the fractures and early initiation of post-operative movement. The functions of the upper limb and activities of daily living are affected if this mechanism is not restored.[4]
In our case, the patient had both bone forearm fracture with an ipsilateral intra articular distal end radius fracture. To span these 2 fractures in radius, 2 plates were required for anatomical reduction and adequate fixation.
The interface between the bone and tip of a plate is considered as a region with maximum stress which may lead to peri plate fracture, especially in elderly population. When 2 plates are used adjacent to each other, it creates a stress riser at the intersection of these 2 plates with subsequent fracture in this region. It is stated in literature that if 2 implants are to be used in same area, they must overlap to reduce the stress riser. Placing the 2 plates in different planes would pose difficulties in placing the second plate in same dissection and difficulties in screw insertion. Hence overlapping of plates in same plane in such fractures have better outcome.[5]
The use of single long plate for radius was avoided to prevent the excessive shearing forces of such a construct. Also this is a single incision approach for radius which saves some operative time and blood loss.