Spring-Wire Technique as a Cost-Effective Alternative for Volar Rim Fragment Fixation in Distal Radius Fractures

Introduction Volar rim fragment fixation is difficult to manage, as it is distal to the watershed line, rendering normal volar plates unable to securely capture it. This fragment must be precisely addressed as volar carpal subluxation is unavoidable when fixation is not efficient. The spring-wire technique maintains a stable fixation of this key fragment, which has been previously described in a small series. Materials and methods This is a prospective study of 20 patients who presented to El-Hadara University Hospital in Alexandria between the years 2020 and 2022, with complex distal radius fractures and small volar rim fragments, who were treated by open reduction and internal fixation using the spring-wire technique. The study was approved by the institutional review board of Alexandria Main University Hospital, and informed consent was taken from all patients in this study ensuring compliance with ethical standards. All patients underwent open reduction and internal fixation using the spring-wire technique. The procedure was performed by the same surgical team to ensure consistency. Postoperative radiographs were taken to assess reduction quality and fixation. Postoperative radiographic parameters, range of motion, grip strength and the El-Hadara wrist function scoring system were obtained after one year of follow-up, to evaluate results of fixation. Results All patients achieved a functional range of motion and grip strength and showed radiological union of the volar rim fragment with no volar carpal subluxation or escape of the volar rim fragment. The El-Hadara wrist function average score was 18.85±2.66, which represented a good overall result. No complications occurred during follow-up, and none of the patients required removal of the implant. Conclusion The spring-wire technique maintains a stable fixation of the volar rim fragment that cannot be held securely by volar plating alone. This method offers a low-profile implant that is readily available and simple to apply. Also, the fragment is stabilized by a dual effect by both the spring wire and the volar plate that act as a buttress to volar displacement.