Can a generic fracture fixation assessment tool be used to assess quality of distal radius fracture fixation, and predict fixation failure?

INTRODUCTION: Failure following volar locking plate fixation of distal radial fractures (DRFs) is a common cause of revision surgery. The Fracture Fixation Assessment Tool score (FFAT) is a validated evaluation tool for appraising long bone fracture fixations. It comprises of four domains: reduction, stability, implant choice and overall impression. This study evaluates FFAT as an educational tool for assessing DRF fixation quality. A secondary aim is to analyse its ability to predict fixation failure. METHODS: A pool of 63 DRF fixations, including 22 failures, were scored by 27 orthopaedic surgeons using FFAT, with each participant assigned a set of 10 DRF fixations. The overall score and individual domain scores for failed and non-failed fixations were compared using unpaired Student's t-tests. The ability of FFAT to identify fracture fixation failure was analysed using binomial logistic regression and a receiver operating characteristic curve. RESULTS: Lower FFAT scores correlated with poor quality fracture fixations that subsequently failed, with statistical significance demonstrated in reduction and overall impression domains. Reduction was the strongest predictor of poor fixation with subsequent failure. Regression analysis demonstrated FFAT scores to exhibit good specificity but limited sensitivity in predicting failure. CONCLUSION: FFAT provides a structured, reproducible framework for the formative educational assessment of distal radius fracture fixation. Although lower scores were associated with fixation failure, limited sensitivity restricts its reliability as a standalone clinical predictive tool. Refinement of FFAT domains to better reflect distal radius-specific fixation principles may enhance failure detection while preserving its primary educational role.