In a distal radius fracture with dorsal tilt >20°, radial shortening >5 mm, and articular step-off >2 mm, which implant provides the BEST biomechanical advantage?

• A Volar locking plate ✓
• B Dorsal plate (Pi plate)
• C External fixator with ligamentotaxis
• D Intramedullary nail

Explanation

Volar locking plates (e.g., DVR, Aptus, DepuySynthes LCP) are the current gold standard for unstable distal radius fractures with dorsal comminution, radial shortening, and articular step-off. The volar locking plate acts as a fixed-angle device; locking screws into the dorsal cortex prevent dorsal collapse even in osteoporotic bone. Dorsal plates have higher extensor tendon complication rates. External fixation with ligamentotaxis cannot reliably correct articular step-off. Intramedullary nails are suitable for extra-articular fractures only.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.