gms | German Medical Science

Introduction: Distal radius fractures, occasionally present with comminution in the palmar side and are a challenge for the hand surgeon, Some fractures have an important anterior comminution that makes it difficult to have sufficient bone contact with the plate. Fixation can be made with a "bar" support screw. It is a screw placed from radial to ulnar in a transversal way and over the metaphysis of the distal radius. This will generate a support to the entire distal row of the plate, functioning as a transverse bar and the palmar plate have anti-shear support and not only depend on the locked screws. In addition, it will also close the joint gap by making compression.

Objective: Technique of osteosynthesis the application of a screw as a substitute anterior cortical metaphyseal anti-shear, when it is not possible to perform a fixation with the palmar plate of the radius given the comminution of the fracture.

Methodology: Clinical case of a male patient, a 50 years old, with a Fernández V, type fracture with anterior comminution, an intraarticular involvement in two planes and a metaphyseal fracture line with impaction and loss of radial height and carpal subluxation. The "bar" screw technique was used to control shear and achieve anterior cortical augmentation of the fixation to decrease the risk of failure.

Results: Patient with follow-up at 6 months with complete mobility arches, with restitution of the articular surface, with QuickDASH of 6.81%, analogous visual scale of pain of 1. Postoperative radiographs with consolidation without failure of osteosynthesis material. With return to work activity within the month of the procedure.

Conclusion: When the traces of comminution are multiple and small, and there is no space to place the fixation screws through the holes in the plate because the screws have an insufficient bone segment for their fixation or because the screw is directed through the vertical line of the fracture, the "bar screw" gives the transverse support so that, with the plate support effect, it is possible to contain in its place the palmar edge distal of the fracture of the radius. In clinical cases where palmar comminution is severe and does not allow an adequate fixation of the plate, a screw can be used as a "bar" or support in the distal metaphyseal part so that it allows to control the shearing forces.