Technique Spotlight

Fragment-specific fixation utilizes multiple implants, through one or more incisions, each designed to secure an individual fracture fragment. In comminuted intra-articular distal radius fractures, the epiphysis commonly separates into five characteristic fragments with fault lines at the intervals between radiocarpal ligament attachments. The most common fragments include the radial column, dorsal ulnar corner, dorsal wall, volar rim or volar ulnar corner, and free intra-articular fragments. The goals of fragment-specific techniques are to achieve direct open visualization, manipulation, and buttress-style fixation of each fragment to facilitate anatomic reduction and create a load-sharing construct. Fragment-specific implants can be utilized in isolation, in combination, or as adjunctive fixation to other fixation methods to stabilize very distal or highly comminuted distal radius fractures. This technique spotlight details the steps to patient assessment and selection, approaches, reduction techniques, and fixation options for fragment-specific fixation of complex distal radius fractures.