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Distal radius fractures remain among the most common fractures of the upper extremity. The indications for operative management continue to evolve based on outcomes from the most recent clinical studies. Advancements over the past decade have expanded the variety of fixation options available; however, the clinical superiority of a particular treatment modality remains without consensus. Each approach requires the use of unique surgical techniques, and the choice of a particular implant system should be based on the surgeon's familiarity with the implant design and its limitations. As our understanding of the management of distal radius fractures improves, so will our indications for each specific treatment modality.

Purpose The primary objective of this study was to compare incidence, demographic trends, and rates of subsequent fusion between proximal row carpectomy (PRC) and 4-corner fusion (4CF) among patients in the United States. Methods A total of 3,636 patients who underwent PRC and 5,047 who underwent 4CF were identified from the years 2005 through 2014 among enrollees in the PearlDiver database. Regional distribution, demographic characteristics, annual incidence, comorbidities, and subsequent wrist fusion were compared between the 2 groups. Of the patients identified, 3,512 from each group were age- and sex-matched and subsequently compared for rates of converted fusion, 30- and 90-day readmission rates, and average direct cost. Results Patients undergoing 4CF and PRC did not have statistically significant differences in comorbidities. The incidence of the procedures among all subscribers increased for both PRC (1.8 per 10,000 to 2.6 per 10,000) and 4CF (1.2 per 10,000 to 2.0 per 10,000) from 2005 to 2014. Comparing the matched cohorts, patients who underwent 4CF had a higher rate of subsequent fusion than those who underwent PRC (2.67% vs 1.79%). Readmission rates were not significantly different at 30 or 90 days. Average direct cost was significantly greater for 4CF than for PRC. Conclusions Both PRC and 4CF have been utilized at increasing rates in the past decade. Wrist fusion rates and average costs are higher in the 4CF group without a significant difference in readmission rates. Type of study/level of evidence Therapeutic III.

Purpose To describe a novel construct for proximal interphalangeal (PIP) joint arthrodesis using headless cannulated screws as an intramedullary washer to augment 90/90 intraosseous wiring and compare the biomechanical properties of this construct with those of the 90/90 intraosseous wiring without headless screw augmentation. Methods Biomechanical evaluation of augmented 90/90 intraosseous wiring with headless cannulated screws (group 1) or 90/90 intraosseous wiring without augmentation (group 2) for PIP joint arthrodesis was performed in 3 matched-pair cadaveric specimens (12 digits per group). Each group was loaded to 10 N in the sagittal and coronal planes and the resultant stiffness from the load-displacement curve was calculated. In extension, each group then underwent load to permanent deformation and load to catastrophic failure. Results The augmented 90/90 intraosseous wiring with cannulated screws construct demonstrated significantly greater stiffness by 132%, 64%, 79%, and 75% in flexion, extension, ulnar, and radial displacement, respectively. During load to permanent deformation testing, a 42% greater force was required to create permanent deformation in group 1 compared than group 2. There was no significant difference between the 2 groups during load to catastrophic failure testing. Conclusions Augmenting 90/90 intraosseous wiring for PIP joint arthrodesis with 2 headless cannulated screws in the sagittal plane that serve as intramedullary washers for the sagittal wire and posts for the coronal wire significantly increases stiffness in all directions as well as load to permanent deformation compared with 90/90 intraosseous wiring without cannulated screw augmentation. Clinical relevance Augmentation of the 90/90 intraosseous wire construct with headless cannulated screws can be considered in patients at risk for wire cutout or implant failure.

Purpose To compare the biomechanical properties of second versus third metacarpal distal fixation when using a radiocarpal spanning distraction plate in an unstable distal radius fracture model. Methods Biomechanical evaluation of the radiocarpal spanning distraction plate comparing second versus third metacarpal distal fixation was performed using a standardized model of an unstable wrist fracture in 10 matched-pair cadaveric specimens. Each fixation construct underwent a controlled cyclic loading protocol in flexion and extension. The resultant displacement and stiffness were calculated at the fracture site. After cyclic loading, each specimen was loaded to failure. The stiffness, maximum displacement, and load to failure were compared between the 2 groups. Results Cyclic loading in flexion demonstrated that distal fixation to the third metacarpal resulted in greater stiffness compared with the second metacarpal. There was no significant difference between the 2 groups with regards to maximum displacement at the fracture site in flexion. Cyclic loading in extension demonstrated no significant difference in stiffness or maximum displacement between the 2 groups. The average load to failure was similar for both groups. Conclusions Fixation to the third metacarpal resulted in greater stiffness in flexion. All other biomechanical parameters were similar when comparing distal fixation to the second or third metacarpal in distal radius fractures stabilized with a spanning internal distraction plate. Clinical relevance The treating surgeon should choose distal metacarpal fixation primarily based on fracture pattern, alignment, and soft tissue integrity. If a stiffer construct is desired, placement of the radiocarpal spanning plate at the third metacarpal is preferred.