Column-Specific Distal Radius Fracture Fixation

Despite the popularity and success of volar fixed angle plating, variations in distal radius fracture presentation underscore the importance of understanding different surgical treatment options to maximize patient outcomes. The 3-column theory of wrist mechanics provided the foundation for using a column-specific fixation approach. Implant placement within the ulnar column can be challenging because of anatomical constraints. Some have described "safe zones" for implant position to decrease the potential for tendon impingement. A thorough understanding of the surrounding anatomy can allow fixation decisions based on fracture fragment location. Literature reports have shown excellent results when using fragment specific fixation constructs and similar outcomes when comparing these constructs with volar locked plating. Achieving optimal outcomes in surgically treated distal radius fractures requires the surgeon to be competent along a spectrum of surgical approaches and fixation constructs.