Volar rim fracture of the distal radius: management when fragment-specific fixation is not feasible – a case report
Hesam Alitaleshi, Kamran Eftekhari, Seyed A. SeyedifardIntroduction and importance:
Volar rim fractures of the distal radius are uncommon injuries, accounting for approximately 1–11% of distal radius fractures. Despite their rarity, they are clinically significant because of their association with critical radiocarpal ligament attachments and the technical challenges of achieving stable fixation, particularly when the volar fragment is too small for fragment-specific implants.
Case presentation:
A 24-year-old female sustained a volar rim fracture of the distal radius with radiocarpal subluxation following a motor vehicle accident. Surgical fixation was performed through an extended flexor carpi radialis approach. Fracture reduction was achieved using Kirschner wires and stabilized with a 3.5-mm buttress plate because fragment-specific fixation was not feasible. At the 6-month follow-up, the patient had regained full wrist range of motion, was pain-free, and had returned to normal daily activities without evidence of radiographic instability.
Clinical discussion:
Stable fixation of volar rim fractures remains technically demanding because standard volar locking plates may inadequately capture small distal fragments and have been associated with failure rates of up to 24%. Although fragment-specific fixation remains the preferred treatment when feasible, the pin-and-plate technique provides a practical and reliable alternative in situations where dedicated implants are unavailable or cannot be applied safely.
Conclusion:
The pin-and-plate technique represents an effective surgical option for managing selected volar rim fractures of the distal radius when fragment-specific fixation is not feasible, providing satisfactory clinical and radiological outcomes while maintaining radiocarpal stability.