gms | German Medical Science

Objectives/Interrogation: Fixation of volar rim in distal radius fracture remains challenging. Small fragment of volar rim fracture may not be easily fixed with conventional implants. Currently, the fixation methods for volar rim fracture includes volar rim plates, fragment-specific devices and pin-plate construct. Volar rim plates can cover more volar rim area compared to regular volar plates, but they also cause more tendon irritation and volar radiocarpal impingement. As a result, volar rim plates usually need to be removed after fracture union. Fragment-specific devices includes small hook plates or various buttress pin implants. They can effectively fix small volar fragments without causing much soft tissue irritation or impingement. However, this kind of implants may not be available in many countries or facilities. Pin-plate construct was also proposed for volar rim fracture, using the common volar plates and Kirschner wires which are available for most facilities. Compare to volar rim plates, pin-plate construct may also cause lesser hardware irritation since the plate is not placed distal to watershed line. Combined with wrist arthroscopy, accurate reduction of volar fragment can be achieved.

Methods: In this article, we demonstrate our cases using arthroscopic-assisted reduction and internal fixation of volar rim fracture with pin-plate construct. Three patients with volar rim distal radius fracture were treated with this method. Bony union were achieved in all three patients without further displacement. No volar tendon irritation or impingement were noted. One patient with poor compliance of physical therapy results in limited wrist flexion and extension, which need for further implant removal and arthroscopic release after one year. Another patient developed extensor pollicis longus tendon rupture about 5 months after operation, which tendon transfer was done.

Results and Conclusions: Arthroscopic-assisted reduction and internal fixation with pin-plate construct can effectively fix volar rim fracture of distal radius. Advantage of this method includes accurate reduction, reliable volar rim fixation with lesser volar tendon irritation. However, proper pin length and adequate post-operative rehabilitation can be crucial for avoidance of complications and achieving better outcomes.