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Distal Radius Fractures and the Volar Marginal Fragment: Spring Wire Fixation in Addition to Locked Volar Plate Fixation
Amy M. Moore, MD; Washington University School of Medicine; David Dennison, MD; Mayo Clinic
Mayo Clinic, Rochester, MN, USA

Background:The volar marginal fragment of a distal radius fracture may not be stabilized with volar locked plating alone due to the small size and distal location of the fragment. The addition of spring wire fixation to volar plating can provide stable internal fixation of this critical fracture fragment without complication from the fixation.

Methods: A retrospective review (2006-2011) identified nine patients with AO type C distal radius fractures with an associated volar marginal fragment that were treated with volar locked plating and spring wire fixation of the volar marginal fragment. Radiographs, range of motion and grip strength were measured at the last visit. The Patient-Related Wrist Evaluation (PRWE) was obtained to assess pain and functional difficulties. Complications were also recorded.

Results:All distal radius fractures healed and the volar marginal fragment reduction was maintained with the spring wire fixation and volar locked plating. Mean follow-up was 51 weeks (range, 13 -199 weeks). Mean active range of motion was 43° wrist flexion, 51° wrist extension, 75° forearm pronation , and 71° forearm supination. Of those recorded (n=8), the mean grip strength was 21 kg, achieving 66% of the uninjured side. The average PRWE score was 17. One patient required a carpal tunnel release eight months after distal radius repair. No patient required removal of hardware or had evidence of flexor or extensor tendon irritation.

Conclusions:The addition of spring wire fixation to volar locked plating provided stable fixation of the volar marginal fragment of distal radius fractures. This technique addresses a limitation of volar locked plating and potentially extends the indications to control the small volar marginal fragment in distal radius fractures otherwise amenable to volar plating.

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