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Alternative Volar Fixation for Distal Radius Fractures
Kirk A Kaiser, MD1, Cody A Kaiser, MSIV2, Mikeala Rice, MSIV2 and Thomas J Christensen, MD1, (1)Reno Orthopedic Clinic, Reno, NV, (2)University of Nevada, Reno, NV


Increasing distal radius fracture fixation has led to an increase in more distal placement of standard distal radius plates. Many designs are limited to the watershed line. Plates pushed distally create a higher grade Soong classification and possible increases in plate removal or tendon rupture. Plates positioned appropriately may not provide adequate fixation for more distal fractures. We report on an alternative fixation that could be used for fractures beyond the watershed line.

Materials and Methods:

We retrospectively reviewed 153 fractures that were treated with 2 fragment specific hook plates (Trimed). The fractures were type A or B fractures with a split in the coronal plane. The x-rays were reviewed at first post-operative visit and last documented clinic follow-up. X-ray measurements included dorsal tilt, radial inclination, and ulnar length. Quick Dash scores were obtained through phone call and email follow up.


X-ray evaluation didn't seem to change significantly from first and last postop visits. Average between follow-up was 110 days. X-ray measurements were radial inclination 20 degrees, ulnar positive variance of 1mm, and dorsal tilt of +5 degrees. 49 patients were contacted (average 38 months postop) and Quick Dash scores (average 11.6) obtained.


With internal fixation of distal radius fractures, the watershed line is an important anatomic landmark in the technique of standard plate fixation. However, the fracture and patient anatomy often dictate the most appropriate fixation method. Both plate design and Soong classification may increase tendon irritation and eventual rupture. We present an alternative volar fixation method that provided acceptable results in patients with fracture patterns that may not be amenable to standard plate fixation.

1st Postop

Last Postop

Radial Inclination


SD: 4.46


SD: 4.84

Ulnar Variance

+0.9 mm

SD: 2.2 mm

+1 mm

SD: 2.1 mm

Dorsal Tilt


SD: 7.04


SD: 7.33

Average Time Between 1st and Last Postop X-rays: 110 days




Patient Reported

3- Bad Scar

2- Pain

1- Thumb Pain

1- Hand shakes

2- Unreported

No reported tendon ruptures

n = 153 class A & B distal radius fractures


2 Short = 91

2 Long = 30

1 of each = 32

K-wire supplementation = 21

Number of patients with plates removed


5 plates removed while removing other hardware

4 plates removed for pain/stiffness

Quick Dash Survey

49 responses - Average 38 months post-op

Average Quick Dash Score


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