Fragment-specific fixation of complex distal radial fractures with small intraarticular fragments; volar locked plate augmented with Kirschner wires

Abstract

Background: Complex intraarticular distal radial fractures associated with small articular fragments or distal radioulnar instability are difficult to treat and have a worse prognosis because of their potential for incongruity and arthrosis of the radiocarpal and distal radioulnar joints. Although treatment of these fractures has improved over the past decade, there is no single implant or technique that is appropriate for treatment of all fractures. Methods: From 2007–2010, 29 patients with 31 complex distal radial fractures (AO type C) with intraarticular fragments (two fractures were bilateral) were treated with open reduction and internal fixation with volar locked plate augmented with Kirschner wires. Results: After a mean follow-up of 30 mo (range: 28–36 mo), 87% of the patients were satisfied with the treatment and resumed their preoperative activities. According to Gartland and Werley clinical and radiographic scoring system, excellent results were achieved in 13 fractures (42%), good results in 14 (45%), fair results in three (10%), and a poor result in one (3%). Conclusions: We concluded that, although volar plating is a good treatment modality for treatment of complex distal radial fractures, it should be augmented with Kirschner wire fixation outside the plate in fractures with small fragments of the radial styloid, lunate or sigmoid fossa and in fractures that have associated distal radioulnar joint instability or displaced ulnar styloid fracture.