A Loop-Wiring Technique for Volarly Displaced Distal Radius Fractures With Small Thin Volar Marginal Fragments

Abstract

Volarly displaced distal radius fractures (VD-DRFs) with small thin volar marginal fragments (VMFs) are challenging to treat with conventional volar locking plates (VLPs) alone. Several alternative surgical options have been reported to treat these fractures, including wire-loop fixation, spring-wire fixation, hook plates, headless compression screws, and tension-band wiring, but the optimal method is yet to be determined. We have devised a surgical treatment for these fractures, entitled the "loop-wiring method" in which VMFs are anatomically reduced and 2 0.043-inch K-wires are drilled through the volar tip of the fragment and introduced into the dorsal cortex. Two bone tunnels are then made with a 0.039-inch K-wire, before a 0.028-inch soft wire is passed from the volar to the dorsal side and tightened over the dorsal cortex. After a fracture at the volar rim, even if properly reduced, compression stress is continuously generated on the volar cortical side of the fracture site and tension is generated on the articular side, which leads to VMF displacement, articular surface widening, and carpal subluxation. The loop-wiring technique applies compressive pressure securely to the articular side of the fracture site as well as to the whole fracture site and may be advantageous in terms of secure fixation of small thin volar marginal fragments, stability of the carpus, and bone healing.

Keywords: Carpal instability; distal radius fracture; loop-wiring technique; lunate facet fragment; volar marginal fracture.