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

Abstract

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.

Keywords: distal radius fracture; volar hook plate; volar ulnar rim fracture.

Fig. 1

(A–C) CT scan images showing fracture of the lunate facet. Note the small dimensions and the distal location of the fragment which highlight difficulty encountered when stabilizing these fragments. CT, computed tomography.

Fig. 2

(A) Injury AP and (B) lateral radiographs demonstrating the volar ulnar fracture fragment. (C, D) Note the placement of the volar hook plate distal to the watershed line to allow stable, distal fixation. AP, anteroposterior.

Fig. 3

(A, B) Represents injury radiograph and CT scan and (C, D) postoperative views of a patient who sustained an intra-articular distal radius fracture with scapholunate ligament disruption. (E, F) The distal radius fracture was stabilized with a distal radius plate and a hook plate captured the volar ulnar corner that was distal to the watershed line. CT, computed tomography.