Introduction:

Distal radius fractures are vastly heterogeneous in their mechanisms of injury and fragmentation patterns. The technical goals of surgical treatment include the restoration of length, alignment, and inclination, as well as reduction of articular incongruity at the radiocarpal and the distal radioulnar joints. In appropriately selected patients, operative treatment offers superior outcomes compared with non-operative care in terms of anatomic reduction and grip strength and can avoid complications of closed treatment such as malunion and weakness.

Although numerous fixation constructs are currently used, volar locking distal radius plates are the most popular. The introduction of volar locking plates has led to excellent patient-rated and objective outcomes; however, a new set of complications have surfaced. These complications include flexor and extensor tendon rupture, loss of fixation, intra-articular screw placement, flexor tendon adhesions, and wrist flexion contracture requiring hardware removal and surgical release.

Furthermore, not all distal radius fractures are amenable to volar plate fixation. For example, isolated radial styloid fractures, volar lunate facet fractures, dorsal shear fractures, dorsal ulnar facet corner, and severely comminuted intra-articular fractures are typically treated with devices other than a volar locking plate. Other commonly used fixation methods include bridging and non-bridging external fixation, Medoff’s fragment-specific fixation, and bridge plates in the setting of severely comminuted distal radius fractures or polytrauma patients.

The desire to improve fixation and minimize iatrogenic injury, as well as the appeal of early return to function have, in part, driven the development of new technologies in distal radius fracture fixation. This review will discuss emerging fixation constructs and materials in the operative management of distal radius fractures.

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