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. 2021 Jun 11;11(3):195-202.
doi: 10.1055/s-0041-1729990. eCollection 2022 Jun.

Volar Marginal Rim Fractures of the Distal Radius Have a Higher Rate of Associated Carpal Injuries-A Comparative Cohort Study

Nathan Eardley-Harris  1   2 , Simon B M MacLean  1   2 , Ruurd Jaarsma  1   2 , Jock Clarnette  2 , Gregory Ian Bain  1   2
Affiliations

Volar Marginal Rim Fractures of the Distal Radius Have a Higher Rate of Associated Carpal Injuries-A Comparative Cohort Study

Nathan Eardley-Harris et al. J Wrist Surg. .

Abstract

Background Volar marginal rim distal radius fractures can be challenging due to volar instability of the carpus. The associated carpal injuries, however, have not previously been reported. Purpose The aim of this study was to compare volar marginal rim fractures to other distal radius fractures to determine if there is any association with other carpal injuries. If so, do these injuries lead to further instability and fixation failure? Materials and Methods A retrospective radiological review of 25 volar marginal rim fractures was conducted. This was compared with a comparison cohort of 25 consecutive intra-articular distal radius fractures not involving the volar marginal rim. All radiographs were reviewed for associated carpal injuries, including carpal and ulnar styloid fractures, scapholunate instability, and carpal translocation. Results Volar marginal rim fractures had a significantly higher incidence of associated carpal injuries per patient (2.52 vs. 1.64), scapholunate diastasis (36 vs. 12%), and carpal dislocation (80 vs. 48%). The fixation chosen was more likely to involve a volar rim-specific plate (44 vs. 0%). Following surgical fixation, the volar marginal rim fractures had a significantly higher incidence of carpal instability (56 vs. 24%), failure of fixation (24 vs. 0%), and revision surgery (12 vs. 0%). Conclusions Volar marginal rim fractures have significantly more carpal injuries, scapholunate instability, and volar carpal instability, compared with other distal radius fractures. Despite the use of volar rim-specific plating, volar marginal rim fractures have a significantly higher incidence of persistent carpal instability, including scapholunate instability, ulnar translocation, volar subluxation, failure of fixation, and revision surgery. Level of Evidence This is a level III, retrospective review.

Keywords: carpal injury; distal radius fractures; lunate facet; volar rim.

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Conflict of interest statement

Conflict of Interest G.I.B. mentions payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from IBRA Foundation, and AO Foundation, as well as leadership or fiduciary role in other board, society, committee or advocacy group, unpaid from Australian Hand Surgery Society, Asia Pacific Wrist Association, and International Wrist Arthroscopy Association. The remaining authors do not report any conflict of interest related with the article.

Figures

Fig. 1
Fig. 1
( A , B ) Example of volar marginal rim fracture of the distal radius with resulting volar subluxation of the carpus.
Fig. 2
Fig. 2
Example of postoperative ulnar translocation of the carpus.
Fig. 3
Fig. 3
Example of fixation failure of the volar marginal rim fragment over and around the variable angle standard volar plate.
Fig. 4
Fig. 4
Treatment algorithm for volar marginal rim fractures.
See this image and copyright information in PMC

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