Volar Marginal Rim Fracture Fixation With Volar Fragment-Specific Hook Plate Fixation

Purpose To review the outcomes of patients treated with a volar hook plate specifically designed to capture volar marginal rim fractures. Methods A retrospective study was performed over 18 months of patients treated with a volar hook plate in the management of AO type B or C distal radius fractures with a volar marginal rim fragment. Clinical and radiographic outcomes were evaluated. Results The series included 26 wrists in 25 patients, average age 55 years. Average follow-up was 9 months (range, 3-30 mo). Twenty patients had AO type C fractures and 6 had AO type B fractures. All 6 AO type B were B3 fractures. Of the AO type C, 1 had C1, 7 had C2, and 12 had C3. No patients had loss of fixation of the critical volar ulnar corner and there was no evidence of carpal subluxation. Five patients required hardware removal. Four patients experienced hardware irritation requiring removal of all hardware including the volar hook plate. One patient required partial hardware removal that did not include the volar hook plate. All patients with volar hardware irritation had hook plates that were of second-generation design that had a prominent bend, which has since been modified. There were no cases of tendon rupture. Conclusions Volar marginal rim fragments of intra-articular distal radius fractures are not amenable to standard volar plate fixation. Fragment-specific fixation using a volar hook plate designed specifically for these fragments allowed for stable fixation when combined with other fragment-specific fixation techniques. There was no loss of fixation of the critical corner in this series. Although hardware irritation can occur, fully seated hooks and subsequent modification of the design of the hook bend has diminished this complication. Type of study/level of evidence Therapeutic IV.