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Complex distal radius fracture (CDRF) with median nerve injury management using one-stage distraction bridge plate fixation (DBPF) without nerve exploration allows nerve function recovery: a case report


Background: Complex distal radius fracture (CDRF) associated with median nerve injury is rarely reported due to low incidence or low recognition rate. Thus, we reported the outcome of using distraction bridge plate fixation (DBPF) in managing CDRF associated with median nerve injury without volar nerve exploration.

Case description: We reported a 67-years old male who sustained pain in the right wrist with dorsal angulated deformation following a fall on an outstretched hand two hours before being admitted to the emergency department. The patient also complained of numbness in all of the fingers except the little finger of the right hand. Posteroanterior (PA)/right lateral X-rays showed grossly dorsal displaced of the comminuted distal radius fracture associated with ulnar styloid avulsion. The diagnosis was a CDRF associated with median nerve injury. He underwent surgery in an emergency setting with DBPF on the dorsal side without opening the fracture site guided by an image intensifier. Early mobilization was started as the patient could tolerate the pain, and neuromuscular electrical stimulation was given twice a week after surgery. Plate removal was done six months after surgery and continued with a range of motion exercise of the right wrist.

Conclusion: It is important to consider the anatomical reduction without additional soft tissue trauma by opening the fracture site and the early emergency surgery decision based on physical examination in CDRF management. The stable fixation allows axonal regeneration after median nerve injury, proved by good nerve functional outcomes. DBPF is suitable for post-operative wound care and decreases costs compared to staged fixation surgery and volar nerve exploration. However, we still need to further investigate this procedure through higher comparison studies.


  1. Chung KC, Spilson S V. The frequency and epidemiology of hand and forearm fractures in the United States. J Hand Surg Am. 2001;26(5):908-915.
  2. MacIntyre NJ, Dewan N. Epidemiology of distal radius fractures and factors predicting risk and prognosis. J Hand Ther. 2016;29(2):136-145.
  3. Gde N, Panji A, Sudharma K, Gede Ekawiratnaya I. Distal Radius Fracture Prevalence Among Geriatric Patient in RSUP Sanglah Denpasar 2013-2014. Med Udayana. 2019;8(10):2597-8012.
  4. Nourbakshs A, Tan V. Median nerve fibrosis at the distal forearm after volar plate fixation of distal radius fracture. J Hand Surg Am. 2010;35E(9):768-769.
  5. Ficke B, Ransom EF, Hess MC, et al. Outcomes of Staged Treatment for Complex Distal Radius Fractures. Cureus. 2018;10(9).
  6. Dauzere F, Delclaux S, Pham TT, Rongières M, Mansat P. Combined median and ulnar nerve palsy complicating distal radius fractures. Orthop Traumatol Surg Res. 2018;104(6):871-875.
  7. Dennison DG. Median Nerve Injuries Associated With Distal Radius Fractures. Tech Orthop. 2006;21(1):48-53.
  8. Lauder A, Agnew S, Bakri K, Allan CH, Hanel DP, Huang JI. Functional Outcomes Following Bridge Plate Fixation for Distal Radius Fractures. J Hand Surg Am. 2015;40(8):1554-1562.
  9. Dodds SD, Save A V., Yacob A. Dorsal Spanning Plate Fixation for Distal Radius Fractures. Tech Hand Up Extrem Surg. 2013;17(4):192-198.
  10. Richard MJ, Katolik LI, Hanel DP, Wartinbee DA, Ruch DS. Distraction plating for the treatment of highly comminuted distal radius fractures in elderly patients. J Hand Surg Am. 2012;37(5):948-956.
  11. Huang JI, Peterson B, Bellevue K, Lee N, Smith S, Herfat S. Biomechanical Assessment of the Dorsal Spanning Bridge Plate in Distal Radius Fracture Fixation: Implications for Immediate Weight-Bearing. Hand (N Y). 2018;13(3):336-340.
  12. Hyatt BT, Hanel DP, Saucedo JM. Bridge Plating for Distal Radius Fractures in Low-Demand Patients With Assist Devices. J Hand Surg Am. 2019;44(6):507-513.
  13. Lewis S, Mostofi A, Stevanovic M, Ghiassi A. Risk of tendon entrapment under a dorsal bridge plate in a distal radius fracture model. J Hand Surg Am. 2015;40(3):500-504.
  14. Chu C-H, Chih C-J, Wei K-Y, Tsuang Y-H. Entrapment Of Index Flexor Digitorum Profundus And Median Nerve: An Usual Complication Of Distal Radial Fracture - A Case Report. Kaohsiung J Med Sci. 1998;14:303-307.
  15. Özkan S, Mudgal CS, Evans BT, Watkins CJ, Heng MM, Bloemers FW. Surgical Decision-Making in Median Neuropathy Associated with Distal Radius Fractures. J Wrist Surg. 2019;08(05):366-373.
  16. Bienek T, Kusz D, Cielinski L. Peripheral nerve compression neuropathy after fractures of the distal radius. J Hand Surg Am. 2006;31(3):256-260.
  17. Graham TJ. Surgical Correction of Malunited Fractures of the Distal Radius. J Am Acad Orthop Surg. 1997;5(5):270-281.
  18. Nana AD, Joshi A, Lichtman DM. Plating of the distal radius. J Am Acad Orthop Surg. 2005;13(3):159-171.
  19. Huard S, Blanchet N, Leclerc G, et al. Les fractures du radius distal après 70ans: ostéosynthèse par plaque palmaire ou broches? Chir Main. 2010;29(4):236-241.
  20. Varitimidis SE, Basdekis GK, Dailiana ZH, Hantes ME, Bargiotas K, Malizos K. Treatment of intra-articular fractures of the distal radius. J Bone Jt Surg - Ser B. 2008;90(6):778-785.
  21. Del Piñal F, Klausmeyer M, Moraleda E, De Piero GH, Rúas JS. Arthroscopic reduction of comminuted intra-articular distal radius fractures with diaphyseal-metaphyseal comminution. J Hand Surg Am. 2014;39(5):835-843.
  22. Vakhshori V, Alluri RK, Stevanovic M, Ghiassi A. Review of Internal Radiocarpal Distraction Plating for Distal Radius Fracture Fixation. Hand. 2020;15(1):116-124.
  23. Sharareh B, Mitchell S. Radiographic Outcomes of Dorsal Spanning Plate for Treatment of Comminuted Distal Radius Fractures in Non-Elderly Patients. J Hand Surg Glob Online. 2020;2(2):94-101.
  24. Wolf JC, Weil WM, Hanel DP, Trumble TE. A Biomechanic Comparison of an Internal Radiocarpal-Spanning 2.4-mm Locking Plate and External Fixation in a Model of Distal Radius Fractures. J Hand Surg Am. 2006;31(10):1578-1586.
  25. Margaliot Z, Haase SC, Kotsis S V., Kim HM, Chung KC. A meta-analysis of outcomes of external fixation versus plate osteosynthesis for unstable distal radius fractures. J Hand Surg Am. 2005;30(6):1185.e1-1185.e17.
  26. Sumarwoto T, Poetera CY, Abimanyu D. Peripheral nerve injury and its regeneration processes: a biomolecular point of view. Bali Medical Journal. 2021;10(2):927–934.
  27. Suyasa IK, Lestari AAW, Prabawa IPY, Marta KKA. Water Sport-Related Spine Injury in Bali: A Review and Preliminary Study. Indonesia Journal of Biomedical Sciences. 2019;13(2):72-76.

How to Cite

Satmoko, B. A., & Suroto, H. (2022). Complex distal radius fracture (CDRF) with median nerve injury management using one-stage distraction bridge plate fixation (DBPF) without nerve exploration allows nerve function recovery: a case report. Bali Medical Journal, 11(3), 1897–1902.




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Benedictus Anindita Satmoko
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Heri Suroto
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