Purpose
The purpose of this study is to evaluate the radiographic and clinical outcomes of the Frag-Loc compression screw with palmar plate fixation on distal radius fractures that include a displaced dorsoulnar fragment.

Patients and Methods
This retrospective comparative study enrolled 48 patients who had an unstable distal radius fracture and a dorsoulnar fragment that was more than 2 mm displaced and that had involvement of more than one-quarter of the articular surface. Twenty-six of the 48 patients were treated with a palmar locking plate without a Frag-Loc compression screw (group 1) and the other 22 patients were treated with palmar locking plate with a Frag-Loc compression screw to fix the dorsoulnar fragment (group 2). First, we reviewed all pre-surgical computerized tomographic (CT) scans. Second, we used the gap distance between the dorsoulnar and palmar fragment as seen on post-surgical axial and sagittal CT scans to determine outcome. The gap distance was measured at the point of maximum distance perpendicular to the plane of the main fracture line. Clinical outcomes were evaluated based on the patient-rated wrist evaluation (PRWE) score; the disabilities of the arm, shoulder and hand score; wrist active range of motion; and grip strength.

Results
There were no statistically significant differences in clinical outcome between the two groups. However, there were statistically significant differences in postsurgical gap distance. The mean post-surgical gap distances for group 1 were 1.3 mm (range 0.2–3.8 mm) on axial CT scans and 1.4 mm (range 0.5–2.4 mm) on sagittal CT scans, while the mean post-surgical gap distances for group 2 were 0.7 mm (range 0.7–1.6 mm) and 0.7 mm (range 0.3–1.1 mm).

Conclusion
This study shows that the Frag-Loc compression screw can reduce the gap distance between the dorsoulnar fragment and the distal radius, according to evaluation of post-surgical axial and sagittal CT scans. This result suggests that the Frag-Loc compression screw is an effective and simple treatment option to immobilize a dorsoulnar fragment associated with distal radius fracture.

Summary
Open reduction and internal fixation is the mainstay of treatment for most unstable, intra-articular distal radius fractures. Anatomical reduction and maintenance of the reduction can be challenging in the setting of injuries with multiple fracture fragments and complex intra-articular fracture patterns. Although common, volar locking plates cannot adequately address every fracture pattern. Fragment-specific fracture fixation methods are technically demanding, but can be used alone or in conjunction with other fixation methods to obtain reliable reduction and fixation in complex fracture patterns. The aim of this report is to illustrate the use of the fragment-specific technique for intra-articular distal radius fracture fixation.

Conclusion
The presented case illustrates that a fragment-specific technique may be successfully used for intra-articular distal radius fracture fixation. The fragmentspecific technique may be a valuable adjunct or alternative to volar locked plating and other fixation techniques for fixation of comminuted and intra-articular distal radius fractures. Fragment-specific fixation allows for individualized fixation of small and distal fracture fragments that are critical to maintenance of the reduction and may not be amenable to other types of fixation.

Purpose
To evaluate outcomes of intra-articular distal radius fractures with displaced dorsal lunate facet fragments treated with a combination of volar plating and the use of a dorsal screw that integrates into the plate.

Methods
We reviewed a retrospective cohort of 22 patients who underwent open reduction and internal fixation of an intra-articular distal radius fracture with a volar plate in conjunction with the Frag-Loc Compression screw. Patient charts and radiographs were reviewed for clinical and radiographic outcomes.

Results
A total of 12 patients with a minimum 6-month follow-up who met all eligibility criteria were included in this study. There were 8 women and 4 men. The mean age was 55.2 years. Mean follow-up was 11.5 months (range, 6–21 months). The most common mechanism of injury was a fall from standing (75.0%). At final follow-up, all patients were able to return to their previous level of function. Bony union was achieved in all patients at the time of final follow-up. Average radiographic parameters at final follow-up were radial inclination 24.2° ± 5.3°, volar tilt 1.3° ± 5.2°, and ulnar variance 0.9 ± 1.7 mm. During the follow-up period, transient median nerve paresthesias were observed in 4 patients, with spontaneous resolution in 3 of 4 patients. Loss of articular reduction was not observed in any case.

Conclusions
This study demonstrates satisfactory clinical and radiographic results and minimal complications with utilization of a new fixation device for distal radius fractures with displaced dorsal lunate facet fragments.