The real of distal radius fractures presents a landscape of diverse management approaches. White these fractures are familiar, the occasion Ally unveil exceptional cases that deviate from the usual trajectory, especially if it occurs in the joints posing distinct challenges in their treatment.

A 38-year old man with a history of a left distal radius fracture treated with a plate and screws one year prior sustained a new peri-implant fracture (fracture around the implant) after a fall. He experienced pain at the fracture site but had normal hand function. The X-ray revealed a closed marginal peri-implant fracture at the distal end of the left radius on a locked plate, showing posterior displacement.

For the surgical procedure, a revision of the old incision was performed, allowing removal of the plate and screws. Next, a posterior wrist approach was performed to extract and osteotomize the callus, after which a locked radius plate was placed with bone graft. As a final step, an arm cast was applied. Control radiological images showed a good result.

Clinical and radiological follow-up appointments were scheduled at 1, 3, and 6 months. At 3 months, the patient's wrist range of motion showed improvement: 40 degrees dorsiflexion, 50 degrees palmar flexion, 45 degrees pronation, 45 degrees supination, 5 degrees radial tilt, and 20 degrees ulnar tilt. By 6 months, the DASH score reached 14.2, and the Mayo wrist score was 75. Range of motion continued to improve: 60 degrees dorsiflexion, 80 degrees palmar flexion, 75 degrees pronation, 65 degrees supination, 15 degrees radial tilt, and 45 degrees ulnar tilt.

X-rays confirmed successful healing of the fracture. The patient's wrist range of motion gradually improved over 6 months.

Peri-implant fractures of the distal radius are on the rise due to increased use of volar plates in wrist fracture fixation. These fractures result from a combination of patient factors, biology, and mechanics. Patient health, especially osteoporosis and lifestyle choices like smoking, influences the risk.

The complexity of these fractures, varying in configuration and soft tissue involvement, can lead to implant-related complications.

Peri-implant fractures of the wrist are rare but increasing due to the greater use of plates. High-energy trauma with poor bone quality can cause new fractures around the plate. Careful soft tissue handling, preservation of bone vascularity, and potential bone grafting are crucial.