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

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.

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.

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.

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 III.