Comparison of a standard locking screw versus a double-threaded cortical compression screw for fixation of die-punch fragments in distal radius fractures with volar plating

The aim of this study was to use a compression screw in the epiphyseal medial orifice of a volar plate to reduce and stabilize the die-punch fragment in distal radius fractures (DRF) undergoing open reduction and internal fixation (ORIF). The main hypothesis was that the range of motion (ROM) in supination would be poorer when a standard screw was used. Our case series included 19 patients with an average age of 59 years (24–91) (SD −35.32) (10 male patients and 9 females) who underwent ORIF of DRFs with a volar plate. Group I included 10 patients in which the die-punch fragment was fixed with a standard locking screw and group II included the 9 patients in which the die-punch fragment was fixed with an angle stable compression screw through both cortices. At the 6-month follow-up visit, the average ROM in flexion was 83% in group I and 81% in group II (−2.327 [−13.657; 8.960]), the ROM in extension was 91% and 89% (−2.754 [−13.410; 7.602]), the ROM in pronation was 100% and 102% (+3.178 [−5.242; 11.457]), the ROM in supination 100% and 97% (−3.171 [−10.825; 4.537]), the pain level was 0.6/10 and 1/10 (+0.106 [−0.809; 0.977]), the QuickDASH score was 8.1/100 and 17.17/100 (+5.790 [−2.934; 15.012]), the PRWE was 6.2/100 and 22/100 (+13.109 [4.416; 22.779]) and the grip strength was 95% and 74% of the contralateral side (−12.478 [−24.832; 0.538]). No complications, nonunions or revision surgery were reported in the two groups. One case of secondary displacement of the die-punch fragment occurred in each group. The main hypothesis was not proven. In conclusion, despite what several biomechanical studies have suggested, the use of double-threaded compression screws for die-punch fragment fixation in DRFs does not improve the clinical outcomes compared to standard locking screws. Le but de cette étude était de mettre en place une vis à compression dans l’orifice épiphysaire le plus médial pour réduire et stabiliser en rappel le fragment die-punch au cours de l’ostéosynthèses de fractures de l’extrémité distale du radius (EDR) par plaque antérieure. L’hypothèse principale était que la supination était inférieure avec une vis standard. Notre série comprenait 19 patients d’âge moyen 59 ans (24–91) (SD −35,32) dont 9 femmes, opérés par plaque antérieure verrouillée. Pour les 10 premiers (groupe I), le fragment die-punch a été synthésé par une vis verrouillée standard et les 9 patients suivants (groupe II) par une vis à compression à double pas. À 6 mois, la flexion