Dual Plating and Dorsal Bridge Plating for Comminuted Distal Radius Fractures: A Systematic Review

Background/Objectives: Complex AO type C distal radius fractures remain amongst the most difficult injuries to treat, often requiring advanced fixation techniques. This systematic review focuses on two commonly used strategies for complex injuries: combined dorsal and volar plating and dorsal bridge plating. The goal is to examine reported functional and radiographic outcomes as well as complications of both techniques. Methods: A search was conducted across Embase, Medline, and Web of Science following PRISMA guidelines. Studies were included if they reported clinical or radiographic outcomes in adult patients with complex distal radius fractures treated using either combined dorsal and volar plating or dorsal bridge plating. Results: Sixteen studies were included, encompassing a total of 629 distal radius fractures, 419 treated with combined plating and 210 with bridge plating. Both techniques were associated with improved wrist function and satisfactory radiographic alignment. The weighted mean Disabilities of the Arm, Shoulder, and Hand (DASH) score was 12.07 for combined plating and 25.20 for bridge plating. Radiographically, both techniques restored acceptable volar tilt, with a weighted mean of 5.97° for combined plating and 3.32° for bridge plating. Overall complication rates were low, with reported infection rates of 2.86% for both techniques. Revision rates for complications were 4.30% and 5.71% in dual and bridge plating, respectively. Tendon injuries occurred in 1.19% of patients after combined plating and 1.43% after spanning fixation. Conclusions: This review highlights the promising results of both combined plating and dorsal bridge plating in the treatment of complex distal radius fractures. As surgeons continue to navigate these challenging injuries, further comparative studies are required to determine the optimal management strategy.