Abstract
Background Treatment of intra-articular distal radius fractures (DRFs) rests on anatomic internal
fixation. Fragment-specific fixation (FSF) is applied when fracture pattern is too
complex for standard volar plating (SVP), oftentimes with potential increased risk
of complications. We hypothesized that patients undergoing FSF would achieve less
wrist range of motion (ROM) with higher risk of complications compared with SVP.
Methods We conducted a retrospective review of 159 consecutive patients undergoing DRF fixation
from 2017 to 2020. Patients < 18 years old, < 8 weeks' follow-up, open fractures,
ipsilateral trauma, and fractures requiring dorsal spanning plate were excluded. Patient
demographics, specific construct type, AO fracture classification, ROM, and complications
were assessed. ROM was calculated using average flexion, extension, supination, and
pronation. t -Tests were used to determine differences in ROM among construct types.
Results Ninety-two patients met all inclusion criteria: 59 underwent SVP and 33 underwent
FSF. Average wrist ROM for patients undergoing SVP was 57 degrees/50 degrees flexion-extension
and 87 degrees/88 degrees supination-pronation; average ROM for patients undergoing
FSF was 55 degrees/49 degrees flexion-extension and 88 degrees/89 degrees supination-pronation.
No significant differences were identified when comparing final wrist flexion (p = 0.08), extension (p = 0.33), supination (p = 0.35), or pronation (p = 0.21). Overall reoperation rate was 5% and higher for FSF (12%) versus SVP (2%).
Highest reoperation rate was observed in the double volar hook cohort (80%; N = 4).
Conclusion Construct type does not appear to affect final ROM if stable internal fixation is
achieved. SVP and FSF had similar complication rates; however, double volar hook constructs
resulted in increased reoperations likely from fixation failure and plate prominence.
Level of Evidence Level IV, retrospective review.
Keywords fragment-specific fixation - distal radius fracture - intra-articular - wristhook
plate - column
