Displaced Intra-Articular Fractures Involving the Volar Rim of the Distal Radius

Marcano, Alejandro I.; Taormina, David P.; Karia, Raj; Paksima, Nader; Posner, Martin A.; Egol, Kenneth A.

doi:10.1016/j.jhsa.2014.09.013

Cited by 26 publications

(24 citation statements)

References 16 publications

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“…The evaluation with DASH showed a wide range score from 1.7 to 47.5, with a mean score of 13.5 points due to different pattern and severity of the fractures. The same trend was seen in the PRWE questionnaire with an average score of 9.3 points (range, [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17].…”

Section: Resultssupporting

confidence: 58%

Hook Plate for Volar Rim Fractures of the Distal Radius: Review of the First 23 Cases and Focus on Dorsal Radiocarpal Dislocation

et al. 2018

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Background Fragment-specific fixation of the distal radius is born to fix each articular fragment with limited surgical approach and low-profile devices. Over time, many devices with different designs and characteristics have been developed. However, many of them have showed the inability to securely fix marginal, small, and comminuted fragments as bony ligament avulsions and bony compression injuries. Purpose The purpose of this study was to evaluate the clinical and radiological outcome of a new device born to treat marginal articular fractures of the distal radius. Patients and Methods A retrospective review was conducted on 23 patients with a mean follow-up of 21 months including postoperative clinical evaluation, grip strength, computed tomography scan, and X-ray control. Results All fragments healed and maintained reduced until the final follow-up. The carpus was aligned with the distal radius in all patients presenting with a radiocarpal dislocation. Conclusion The volar rim fragment is an attachment site for the short radiolunate and the volar distal radioulnar ligament. Its unstable fixation can lead to articular incongruity, volar or dorsal subluxation of the carpus, and distal radioulnar instability. The involvement of this fragment on distal radius fractures is relatively common and many studies of the literature have been focused on its treatment. The Hook Plate stabilizes distal fragments at their bone–ligament interface. In addition to bony reduction, the device permits to stabilize the capsule and ligaments, as volar bony ligament avulsions, in a picture of dorsal radiocarpal dislocation. Level of Evidence This is a Level IV, case series.

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Section: Resultssupporting

confidence: 58%

Hook Plate for Volar Rim Fractures of the Distal Radius: Review of the First 23 Cases and Focus on Dorsal Radiocarpal Dislocation

et al. 2018

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“…Results after nonoperative treatment of volar rim fractures are not satisfactory and often require subsequent corrective osteotomy. 1,3,12 The results of surgical treatment of OTA type B3 fracture are comparable to OTA types A and C. This suggests satisfactory outcomes are achieved when the fragments are well reduced and secured regardless of the device type. 1,13 Quantitative three-dimensional computed tomography studies have shown that 16% of the lunate facet project anteriorly from the flat surface of the radius.…”

Section: Discussionmentioning

confidence: 92%

Distal Radius Volar Rim Fracture Fixation Using DePuy-Synthes Volar Rim Plate

2016

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Coronal splits of the distal radius, or volar rim fractures, are classified as fracture type 23B3 according to the Arbeitsgemeinschaft für Osteosynthesefragen (AO)/Orthopedic Trauma Association (OTA) classifications. These fractures are a subset of unstable distal radius fractures caused by shearing forces. 1 Moreover, fractures involving the volar rim can be part of a complex high-energy impaction fracture. Although these fractures are uncommon, their fixation is required to restore wrist and forearm kinematics. 2,3 Unlike some fractures of the dorsal rim, volar rim fractures are rarely amenable to closed treatment. 4 Furthermore, the difference in volar anatomy of the scaphoid and lunate facets increases the complexity of achieving stable fracture fixation if lunate and scaphoid facets are Keywords ► volar rim fracture ► volar rim plate ► distal radius fracture AbstractBackground To assess the results of distal radius fractures with the involvement of the volar rim fixed with the DePuy-Synthes Volar Rim Plate. Case Description We searched for the patients with volar rim fracture and/or volar rim fractures as part of a complex fracture fixed with a volar rim plate. Ten patients met the inclusion criteria: three patients with type 23B3, six patients with type 23C, and one patient with very distal type 23A. The mean follow-up was 14 months (range: 2-26). Fractures healed in all patients. Of the three patients with isolated volar rim fractures (type 23B3), two patients had no detectable deficits in motion. These patients had an average Gartland and Werley score of 9 (range: 2-14). Of the other seven patients (six with type 23C and one with type 23A fracture), three patients healed with full range of motion and four had some deficits in range of motion. Two patients had excellent results, three had good results, and two had fair results using the Gartland and Werley categorical rating. One patient healed with a shortened radius and ulnar impingement requiring a second surgery for ulnar head resection arthroplasty. Literature Review Results after nonoperative treatment of volar rim fractures are not satisfactory and often require subsequent corrective osteotomy. Satisfactory outcomes are achieved when the fragments are well reduced and secured regardless of the device type. Clinical Relevance Volar rim plates give an adequate buttress of the volar radius distal to volar projection of the lunate facet and do not interfere with wrist mobility. Furthermore, the dorsal fragments can be fixed securely through the volar approach eliminating the need for a secondary posterior incision. However, patients should be informed of the potential problems and the need to remove the plate if symptoms develop.

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“…A review of publications specifically addressing fixation of the volar ulnar corner is summarized (►Table 1). 7,8,11,12,[14][15][16][17][18][19] Chin and Jupiter reported on the use of a wire-loop passed through the volar wrist capsule into the distal radius to reduce the lunate facet fragment with good outcomes. 8 This may be an option for fragments which are too small for hardware fixation.…”

Section: Discussionmentioning

confidence: 99%

Stabilization of Volar Ulnar Rim Fractures of the Distal Radius: Current Techniques and Review of the Literature

O’Shaughnessy

Shin

2016

Jnl Wrist Surg

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Background?Distal radius fractures involving the lunate facet can be challenging to manage. Reports have shown the volar carpal subluxation/dislocation that can occur if the facet is not appropriately stabilized. Literature Review?Recent emphasis in the literature has underscored the difficulty in managing this fracture fragment, suggesting standard volar plates may not be able to adequately stabilize the fragment. This article reviews the current literature with a special emphasis on fixation with a specifically designed fragment-specific hook plate to secure the lunate facet. Case Description?An extended flexor carpi radialis volar approach was made which allows access to the distal volar ulnar fracture fragment. Once provisionally stabilized with Kirschner wire fixation, a volar hook plate was applied to capture this fragment. Additional fracture stabilization was used as deemed necessary to stabilize the remaining distal radius fracture. Clinical Relevance?The volar marginal rim fragment remains a challenge in distal radius fracture management. Use of a hook plate to address the volar ulnar corner allows for stable fixation without loss of reduction at intermediate-term follow-up.

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Displaced Intra-Articular Fractures Involving the Volar Rim of the Distal Radius

Cited by 26 publications

References 16 publications

Hook Plate for Volar Rim Fractures of the Distal Radius: Review of the First 23 Cases and Focus on Dorsal Radiocarpal Dislocation

Hook Plate for Volar Rim Fractures of the Distal Radius: Review of the First 23 Cases and Focus on Dorsal Radiocarpal Dislocation

Distal Radius Volar Rim Fracture Fixation Using DePuy-Synthes Volar Rim Plate

Stabilization of Volar Ulnar Rim Fractures of the Distal Radius: Current Techniques and Review of the Literature

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