Management of comminuted, intra-articular distal radius fractures remains a challenge. Basic principles are to obtain anatomic reduction, maintain the reduction, and rehabilitate the injured joint and the patient as soon as possible. This report presents fragment specific fixation as a method for maintaining fractures reduction and allowing early otion.

This was a retrospective consecutive series of AO classified C2 and C3 distal radius fractures treated with fragment specific fixation. Patients were included if their age was between eighteen and sixty years. Part one was a radiographic assessment of seventy-two patients after fracture union. Part two was a comprehensive functional assessment, carried out by a blinded observer in the first twenty-three patients, six months post op.

Mean patient age was thirty-nine years. The most common combination of fixation was a radial pin plate with an ulnar pin plate, although twenty-eight different combinations were found. Part one (radiographic) results were mean final radial inclination angle 21°, mean final palmar tilt 3.7°, mean final ulnar ariance +0.7mm, mean final intra-articular gap 0.9mm, mean final intra-articular step 0.7mm. Part two (functional) results were mean grip 21kg; mean key pinch 10kg; mean ranges of motion pronation 74°, supination 69°, extension 59°, flexion 48°, radial deviation 17°, ulnar deviation 22°; and mean return to work twenty-one weeks. Mean scores in Patient Rated Wrist Evaluation and Disabilities of the Arm, Shoulder, and Hand were twenty and fourteen, respectively.

In the short term, the functional results of ragment specific fixation of ifficult distal radius fractures produced results similar to other methods described in the medical literature. The technique, however, allowed early wrist motion, and produced long term radiographic results well within Cooney’s criteria for optimal reduction. It is expected, therefore that long-term results will prove to be superior to other management techniques.