Acu-Loc® 2 Wrist Plating System

Supplemental Use Guide—Volar Rim Fragment Fixation

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Acumed® Acu-Loc® 2 Wrist Plating SystemA comprehensive system to treat fractures of the distal radius and distal ulna, the Acu-Loc 2 Wrist Plating System offers Standard, Variable Angle Locking, Fragment-Specific, and Extension Plates to address a variety of fracture patterns.

Small fragments at the volar rim are rare but can be a challenge to address due to their distal location to the watershed line. The following two surgical techniques, which are used in conjunction with the Acu-Loc 2 VDR plates, are intended to address these volar rim or marginal volar fractures of the distal radius.

This guide is intended for supplemental use only and is not intended to be used as a stand-alone surgical technique. Reference the Acu-Loc 2 Wrist Plating System Surgical Technique (HNW00-06) for more information.

bipolar cautery was used to achieve hemostasis. The distal radialulnar joint was evaluated in neutral, full supination, and full pro-nation. This was found to be stable in comparison with the contra-lateral side. The wound was irrigated and closed. The patient wasplaced in a volar resting splint, which was maintained for 10 days.Ten-day postoperative imaging showed maintained fracture andhardware alignment (Fig. 2). She was instructed to not bear weightthrough the operative upper extremity for 2 weeks. After 10 days,the splint was removed, and the patient began hand therapy 2 weekspostoperatively.Three-monthpostoperative imaging showsahealedfracture with maintained alignment and hardware positioning (Fig.3).

DISCUSSIONAlthough a wide variety of fracture patterns and classification

systems exist, the basic principles of surgical treatment remainto minimize complications and promote early return of wrist

function. Fragment-specific distal radius fixation, either alone orin conjunction with conventional techniques, allows for rigidfixation and early range of motion with restoration of articularcongruity, length, alignment, and rotation with minimal soft-tissue trauma. With several mini-fragment plate and screwoptions available to treat other articular fractures (eg, radialstyloid, volar ulnar corner, and dorsal ulnar corner), the currentfragment-specific fixation technique is versatile and effective inachieving a stable reduction in the many complex fracturepatterns.

Good to excellent outcomes at mid-term follow-up have beenreported for fragment-specific fracture fixation in the litera-ture.19–21 In a review of 81 patients with 85 distal radius frac-tures treated with fragment-specific fixation, no patients had lossof reduction or tendon rupture; however, 6% required a secondprocedure for hardware removal.19 Sammer et al,22 in a compar-ative study of 99 patients with distal radius fractures treated with

FIGURE 2. Ten-day postsurgical fixationradiographs. PA (A), oblique (B), and lat-eral (C) demonstrating fracture reductionwith a volar locking plate with 3 wires.

FIGURE 3. Three-month postsurgical fix-ation radiographs. PA (A), oblique (B), andlateral (C) demonstrating fracture reduc-tion and subsequent healing after place-ment of a volar locking plate with 3 wires.

Fragment-Specific Fixation of Intra-articular Distal Radius Fractures

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved. www.jorthotrauma.com e3

bipolar cautery was used to achieve hemostasis. The distal radialulnar joint was evaluated in neutral, full supination, and full pro-nation. This was found to be stable in comparison with the contra-lateral side. The wound was irrigated and closed. The patient wasplaced in a volar resting splint, which was maintained for 10 days.Ten-day postoperative imaging showed maintained fracture andhardware alignment (Fig. 2). She was instructed to not bear weightthrough the operative upper extremity for 2 weeks. After 10 days,the splint was removed, and the patient began hand therapy 2 weekspostoperatively.Three-monthpostoperative imaging showsahealedfracture with maintained alignment and hardware positioning (Fig.3).

DISCUSSIONAlthough a wide variety of fracture patterns and classification

systems exist, the basic principles of surgical treatment remainto minimize complications and promote early return of wrist

function. Fragment-specific distal radius fixation, either alone orin conjunction with conventional techniques, allows for rigidfixation and early range of motion with restoration of articularcongruity, length, alignment, and rotation with minimal soft-tissue trauma. With several mini-fragment plate and screwoptions available to treat other articular fractures (eg, radialstyloid, volar ulnar corner, and dorsal ulnar corner), the currentfragment-specific fixation technique is versatile and effective inachieving a stable reduction in the many complex fracturepatterns.

Good to excellent outcomes at mid-term follow-up have beenreported for fragment-specific fracture fixation in the litera-ture.19–21 In a review of 81 patients with 85 distal radius frac-tures treated with fragment-specific fixation, no patients had lossof reduction or tendon rupture; however, 6% required a secondprocedure for hardware removal.19 Sammer et al,22 in a compar-ative study of 99 patients with distal radius fractures treated with

FIGURE 2. Ten-day postsurgical fixationradiographs. PA (A), oblique (B), and lat-eral (C) demonstrating fracture reductionwith a volar locking plate with 3 wires.

FIGURE 3. Three-month postsurgical fix-ation radiographs. PA (A), oblique (B), andlateral (C) demonstrating fracture reduc-tion and subsequent healing after place-ment of a volar locking plate with 3 wires.

Fragment-Specific Fixation of Intra-articular Distal Radius Fractures

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved. www.jorthotrauma.com e3

Suture Technique for Fixing Small Volar Ulnar Corner Fragments

This technique utilizes the suture holes located in the ulnar corner of all Acu-Loc 2 VDR Plates (70-03XX) and the distal edge of the DRFS Volar Lunate Suture Plate (70-0334). Please see the ST for more detailed information.

⊲ De-rotate fragment and capsular attachment under direct visualization.

⊲ Multiple sutures are placed in the capsule.

⊲ Sutures are then passed through the suture holes in the plate.

⊲ A nonlocking screw is placed through the oblong slot in the plate.

⊲ Once plate placement is confirmed, the sutures are tied to secure the fragment.

⊲ Place remaining screws.

bipolar cautery was used to achieve hemostasis. The distal radialulnar joint was evaluated in neutral, full supination, and full pro-nation. This was found to be stable in comparison with the contra-lateral side. The wound was irrigated and closed. The patient wasplaced in a volar resting splint, which was maintained for 10 days.Ten-day postoperative imaging showed maintained fracture andhardware alignment (Fig. 2). She was instructed to not bear weightthrough the operative upper extremity for 2 weeks. After 10 days,the splint was removed, and the patient began hand therapy 2 weekspostoperatively.Three-monthpostoperative imaging showsahealedfracture with maintained alignment and hardware positioning (Fig.3).

DISCUSSIONAlthough a wide variety of fracture patterns and classification

systems exist, the basic principles of surgical treatment remainto minimize complications and promote early return of wrist

function. Fragment-specific distal radius fixation, either alone orin conjunction with conventional techniques, allows for rigidfixation and early range of motion with restoration of articularcongruity, length, alignment, and rotation with minimal soft-tissue trauma. With several mini-fragment plate and screwoptions available to treat other articular fractures (eg, radialstyloid, volar ulnar corner, and dorsal ulnar corner), the currentfragment-specific fixation technique is versatile and effective inachieving a stable reduction in the many complex fracturepatterns.

Good to excellent outcomes at mid-term follow-up have beenreported for fragment-specific fracture fixation in the litera-ture.19–21 In a review of 81 patients with 85 distal radius frac-tures treated with fragment-specific fixation, no patients had lossof reduction or tendon rupture; however, 6% required a secondprocedure for hardware removal.19 Sammer et al,22 in a compar-ative study of 99 patients with distal radius fractures treated with

FIGURE 2. Ten-day postsurgical fixationradiographs. PA (A), oblique (B), and lat-eral (C) demonstrating fracture reductionwith a volar locking plate with 3 wires.

FIGURE 3. Three-month postsurgical fix-ation radiographs. PA (A), oblique (B), andlateral (C) demonstrating fracture reduc-tion and subsequent healing after place-ment of a volar locking plate with 3 wires.

Fragment-Specific Fixation of Intra-articular Distal Radius Fractures

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved. www.jorthotrauma.com e3

bipolar cautery was used to achieve hemostasis. The distal radialulnar joint was evaluated in neutral, full supination, and full pro-nation. This was found to be stable in comparison with the contra-lateral side. The wound was irrigated and closed. The patient wasplaced in a volar resting splint, which was maintained for 10 days.Ten-day postoperative imaging showed maintained fracture andhardware alignment (Fig. 2). She was instructed to not bear weightthrough the operative upper extremity for 2 weeks. After 10 days,the splint was removed, and the patient began hand therapy 2 weekspostoperatively.Three-monthpostoperative imaging showsahealedfracture with maintained alignment and hardware positioning (Fig.3).

DISCUSSIONAlthough a wide variety of fracture patterns and classification

systems exist, the basic principles of surgical treatment remainto minimize complications and promote early return of wrist

function. Fragment-specific distal radius fixation, either alone orin conjunction with conventional techniques, allows for rigidfixation and early range of motion with restoration of articularcongruity, length, alignment, and rotation with minimal soft-tissue trauma. With several mini-fragment plate and screwoptions available to treat other articular fractures (eg, radialstyloid, volar ulnar corner, and dorsal ulnar corner), the currentfragment-specific fixation technique is versatile and effective inachieving a stable reduction in the many complex fracturepatterns.

Good to excellent outcomes at mid-term follow-up have beenreported for fragment-specific fracture fixation in the litera-ture.19–21 In a review of 81 patients with 85 distal radius frac-tures treated with fragment-specific fixation, no patients had lossof reduction or tendon rupture; however, 6% required a secondprocedure for hardware removal.19 Sammer et al,22 in a compar-ative study of 99 patients with distal radius fractures treated with

FIGURE 2. Ten-day postsurgical fixationradiographs. PA (A), oblique (B), and lat-eral (C) demonstrating fracture reductionwith a volar locking plate with 3 wires.

FIGURE 3. Three-month postsurgical fix-ation radiographs. PA (A), oblique (B), andlateral (C) demonstrating fracture reduc-tion and subsequent healing after place-ment of a volar locking plate with 3 wires.

Fragment-Specific Fixation of Intra-articular Distal Radius Fractures

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved. www.jorthotrauma.com e3

bipolar cautery was used to achieve hemostasis. The distal radialulnar joint was evaluated in neutral, full supination, and full pro-nation. This was found to be stable in comparison with the contra-lateral side. The wound was irrigated and closed. The patient wasplaced in a volar resting splint, which was maintained for 10 days.Ten-day postoperative imaging showed maintained fracture andhardware alignment (Fig. 2). She was instructed to not bear weightthrough the operative upper extremity for 2 weeks. After 10 days,the splint was removed, and the patient began hand therapy 2 weekspostoperatively.Three-monthpostoperative imaging showsahealedfracture with maintained alignment and hardware positioning (Fig.3).

DISCUSSIONAlthough a wide variety of fracture patterns and classification

systems exist, the basic principles of surgical treatment remainto minimize complications and promote early return of wrist

function. Fragment-specific distal radius fixation, either alone orin conjunction with conventional techniques, allows for rigidfixation and early range of motion with restoration of articularcongruity, length, alignment, and rotation with minimal soft-tissue trauma. With several mini-fragment plate and screwoptions available to treat other articular fractures (eg, radialstyloid, volar ulnar corner, and dorsal ulnar corner), the currentfragment-specific fixation technique is versatile and effective inachieving a stable reduction in the many complex fracturepatterns.

Good to excellent outcomes at mid-term follow-up have beenreported for fragment-specific fracture fixation in the litera-ture.19–21 In a review of 81 patients with 85 distal radius frac-tures treated with fragment-specific fixation, no patients had lossof reduction or tendon rupture; however, 6% required a secondprocedure for hardware removal.19 Sammer et al,22 in a compar-ative study of 99 patients with distal radius fractures treated with

FIGURE 2. Ten-day postsurgical fixationradiographs. PA (A), oblique (B), and lat-eral (C) demonstrating fracture reductionwith a volar locking plate with 3 wires.

FIGURE 3. Three-month postsurgical fix-ation radiographs. PA (A), oblique (B), andlateral (C) demonstrating fracture reduc-tion and subsequent healing after place-ment of a volar locking plate with 3 wires.

Fragment-Specific Fixation of Intra-articular Distal Radius Fractures

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved. www.jorthotrauma.com e3

K-wire Technique for Fixing Small Volar Ulnar Corner Fragments

⊲ Directly reduce the lunate and/or scaphoid facet fragments.

⊲ Insert a K-wire of appropriate size from volar to dorsal into the fragment. Repeat as needed.

⊲ Cut the K-wire down and bend proximally to contour to the volar aspect of the distal radius.

⊲ Select the appropriate Acu-loc 2 VDR Plate (70-03XX) that adequately covers the K-wires and addresses the remaining distal radius fracture.

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HNW10-12-A | Effective: 2020/09 | © 2020 Acumed® LLC