Response To: Beware the Volar Ulnar Fragment in a Comminuted Bartons Fracture

Abstract

We read with interest the article by Tan et al. 1 and agree that the AO 23 B3 fracture may re-displace following attempted volar plate fixation. In our experience the fracture posing the greatest challenge is a distal exiting fracture line with a small volar lip fragment. 2 Traditional volar plate design provides a more proximal buttress on the volar calcar to avoid plate prominence at the watershed line. In addition the AO 23 C.2 and C.3 fractures with comminution of the articular surface or metaphyseal comminution with an axial fracture line separating the joint fragments from the main metaphyseal volar fragments also pose a risk of volar displacement. Traditionally we would have used additional sub-articular volar lag screws distal to the plate in the B3 fracture and dorsal plating for the C.2 and C.3 configurations. The lack of volar support may render the whole of the reduced construct to collapse at the proximal calcar fracture line necessitating the use of an additional extra-articular volar plate to provide a volar buttress. It is now our practice to use the AO volar rim plate for fixation of such fractures through a single volar approach. We have treated 24 cases using this approach without any cases or redisplacement. The drawback of this technique is the distal plate placement potentially causing flexor irritation, the risk of articular penetration necessitating the use of variable angle distal screw and the limited fixation options of the radial styloid in fractures with extreme comminution.

Distal radius volar rim plate: Technical and radiographic considerations

“…Rarely they were treated with a external fixator or a temporary 3.3 mm 16 hole distraction bridge plate spanning the fracture site and carpus[3]. Both of these techniques offer reliable fracture union, but unlike the volar rim plate, it is not possible to restore most aspects of distal radius anatomy as well as radio-carpal and distal radio-ulnar congruity.…”