Using Trident distal radial locking plate to fix the fracture of distal radius volar rim

Sep 29, 2026

Background: Volar locking plates are widely used for distal radius fractures but show limitations with small volar rim fragments around the watershed line, where inadequate fixation can cause carpal instability, subluxation, or dislocation. This retrospective study evaluates clinical outcomes of a novel Trident distal radial (TDR) locking plate for fractures involving the intermedium column edge (lunate fossa volar rim). Methods: 25 patients treated between 2016 and 2019 were assessed using VAS Pain, PRWE, DASH, ROM, grip strength, radiographic alignment, and hardware-related reoperations.

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CategoryHealthcare

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INTRODUCTION

METHODS

J Chin MedAssoc Original article Using Trident distal radial locking plate to fix the fracture of distal radius volar rim Yin-Ming Huanga, Chun-Yu Chena, Kai-Cheng Lina, Wei-Yi Laib, Yi-Ying Linb,c, Yun-Ju Fub, Yih-Wen Tarnga,d,* aDepartment of Orthopedics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC; bDepartment of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; cInstitute of Pharmacology, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC; dDepartment of Orthopaedics, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC Abstract Background: The volar locking plates have been widely used in a variety of distal radius fractures, but they still have several limitations when dealing with small fragments located around the watershed line with widely reported complications. The volar rim fragments play a critical role in radiocarpal joint stability and failing to secure the volar rim fragment usually results in carpal instability, subluxation, or even dislocation. This study investigates clinical outcomes in the use of a novel implant, the Trident distal radial (TDR) locking plate to treat distal radius fracture with the intermedium column edge (lunate fossa volar rim) fragment involvement. Methods: A retrospective study of 25 patients was conducted, all patients had intermedium column fractures with lunate fossa volar rim involvement and treat with the TDR between January 2016 and December 2019. The clinical assessment outcomes included VAS Pain, PRWE, and DASH scores. Objective measurements included ROM of the injured wrist and grip strength. Final radiographs were used to evaluate radial inclination, volar tilt, ulnar variance, and distal radioulnar joint instability. Secondary operations related to hardware complications were also recorded. Results: The outcome revealed that the mean VAS Pain Score was 1.3, mean DASH score was 10.5, and mean PRWE score was 9.3. Objective measurements revealed good ROM recovery and an 89% gripping strength recovery compared with contralateral hand. Radiographic measurements revealed good maintenance of volar tilt, radial inclination, and mean ulnar variance. There were no complications related to the implant and all fracture sites were union. Conclusion: We believe that the TDR provided more stable fixation among distal radial fractures that predominantly involved the intermedial column and volar rim fragment, and allowing early rehabilitation. We could obtain excellent results in the wrist ROM, gripping power, and Pain Score (VAS) . Keywords: Distal radius fracture; Fragment-specific fixation; Intermedium column; Trident distal radial (TDR) locking plate; Volar rim 1. INTRODUCTION The distal radial fracture is one of the most common fractures of the upper extremity and accounts for 10% to 20% of all fractures in adults.1 The volar locking plate (VLP), introduced in the year 2000 and now widely used, has significantly changed the treatment protocol for unstable distal radius fractures.2 Even though the VLP has generally excellent posttreatment outcomes, it still has several limitations when dealing with small fragments located around the watershed line.3–6 In this fracture pattern, complications have been widely reported, which include implant loss of reduction, carpal instability and subluxation, irritation of flexor and extensor tendons, and implant removal associated with intra-articular screw trajectory and hardware prominence.4–8 * Address correspondence. Dr. Yih-Wen Tarng, Department of Orthopedics, Kaohsiung Veterans General Hospital, 386, Ta-Chung 1st Road, Kaohsiung 813, Taiwan, ROC. E-mail address: qm1047@ms35.hinet.net (Y.-W. Tarng). Conflicts of interest: The authors declare that they have no conflicts of interest related to the subject matter or materials discussed in this article. Journal of Chinese Medical Association. (2023) 86: 426-430. Received September 13, 2022; accepted December 26, 2

FAQs

What is the clinical problem addressed by using the TDR locking plate?

The study targets distal radius fractures with small volar rim fragments around the watershed line, where failing to secure the volar rim can lead to carpal instability or even dislocation.

How were patients and outcomes evaluated in this study?

Twenty-five patients with intermedium column fractures involving the lunate fossa volar rim were treated with the TDR plate (2016–2019). Outcomes included VAS Pain, PRWE, DASH, wrist ROM, grip strength, radiographic alignment measures, and recorded secondary operations related to hardware.

What were the reported results after TDR fixation?

The mean VAS Pain score was 1.3, DASH was 10.5, and PRWE was 9.3. Objective measures showed good ROM and about 89% grip strength recovery, with radiographs indicating maintenance of volar tilt and radial inclination; all fracture sites achieved union and no implant-related complications were reported.

Sep 29, 2026

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