Scaffold Fixation of Multi-Fragmented Intra-Articular Distal Radius Fractures.

OBJECTIVE: Volar locking plates (VLPs) are commonly used to treat displaced intra-articular distal radius fractures (DRFs), but multi-fragmented fractures may require additional dorsal fixation. This study assessed the outcomes of a technique combining VLP and a dorsal bone clamp, described here as "scaffold fixation," and evaluated whether dorsal ulnar corner (DUC) fixation is essential for radiocarpal alignment.

METHODS: In this retrospective cross-sectional study of the ICUC database, 87 patients with DRF with preoperative CT-identified DUC fragments were included. The range of motion was measured, and radiocarpal alignment was evaluated on postoperative and final follow-up radiographs. In addition, we compared cases with long screw purchases or short screw purchases in the DUC with respect to DUC size.

RESULTS: No significant differences were found in flexion, extension, supination, or pronation. DUC size was not associated with screw purchase nor with ROM outcomes. Radiocarpal malalignment was seen in 2% of patients postoperatively and 7% at final follow-up, with no difference between screw purchase groups.

CONCLUSION: Scaffold fixation with a VLP, aided by reduction using a dorsal bone clamp, effectively restores ROM and generally preserves radiocarpal alignment in DRF fixation, regardless of DUC screw purchase or DUC size in this cohort.

LEVEL OF EVIDENCE: Level III.