Comparison of clinical outcomes with and without volar lunate facet fragments in dorsal displaced distal radius fractures

Abstract

Introduction: Although many clinical studies about distal radius fracture (DRF) accompanied by volar lunate facet fragments (VLFF) have recently been reported, none focus on the direction of displacement of distal fragments. Many previous cases with difficulty in treating DRF with VLFF were volar-displaced fractures. Thus, the postoperative risk for re-displacement is different between volar- and dorsal-displaced fractures with VLFF. The aim of this study is to compare the outcome of dorsal-displaced fractures treated using proximal volar locking plates (PVLP) between those with VLFF and those without, in order to reconsider the indications of distal volar locking plates (DVLP) and investigate the possibility of treating dorsal-displaced DRF with VLFF using PVLP.

Methods: The subjects were 122 patients with dorsal-displaced DRFs treated using PVLP (42 males and 80 females, mean age: 59.2 years old). The patients were divided into 13 patients with VLFF group and 109 patients without VLFF group, and the clinical outcomes at 12 months after surgery were compared.

Results: No significant difference was noted on any evaluation between the groups. In addition, no postoperative re-displacement of VLFF was observed and bone union was confirmed. Furthermore, no osteoarthritic change was noted in all patients.

Conclusions: We confirmed that surgical treatment for dorsal-displaced DRF using PVLP is possible even in cases of DRF with VLFF. In addition, DVLP is an implant with a high complication risk; therefore, it may be necessary to reconsider the use of DVLP for dorsal-displaced DRF with VLFF treatable by PVLP.

Keywords: Distal radius fractures; Dorsal displaced fractures; Proximal volar locking plates; Volar lunate facet fragments.

Figure 1

Surgical procedure for distal radius fractures with dorsal-displaced VLFF. From the dorsal side of the fracture region, 1.8-mm Kirschner wire was inserted and dorsal displacement of distal bone fragments was reduced using the Kapandji technique ((A) PA view, (B) Lateral view). Dorsal volar bone fragments were pressed to each other to be bound to reduce the gap in the fracture region ((C) PA view, (D) Lateral view). The plate was placed at a position at which distal locking screws support the dorsal side of the radial joint surface ((E) PA view, (F) Lateral view). The distal bone fragment was reduced and fixed according to the condylar stabilizing method ((G) PA view, (H) Lateral view).

Figure 2

The theory of osteosynthesis and surgical technique of PVLP. In order to prevent dorsal re-displacement, it will be more important to obtain good subchondral support of the dorsal side of the radial facet with PVLP compared with buttress effect by covering the volar lunate facet fragment (yellow arrow: the dislocation direction of the carpal, red line: the dorsal side of the radial facet supported by the locking screw).