Treatment Effectiveness of Volar Plates in Distal Radius Dorsal Rim Fractures

Abstract

Objective To assess the efficacy of distal radius volar plates in cases involving dorsal fragments at the Ulnar Corner (UC) and Lister Tubercle (LT). Methods A retrospective study that included patients with distal radius fractures (DRFs) featuring UC and LT dorsal fragments treated with volar plates. The exclusion criteria comprised lunate facet fractures, UC fragment ratio below 25%, and patients treated with dorsal plates. Radiographic and tomographic measurements included radial length (RL), radial inclination (RI), ulnar variance (UV), palmar tilt (PT), fragment areas, UC fragment ratio, and displacement. The scores on the Gartland Werley (GW) classification and on the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, as well as grip strength, and range of motion (ROM), were assessed. Results The study involved 17 male and 5 female subjects (mean age: 39.7 ± 10.7 years). The UC and LT fragments displayed mean areas of 1.6 ± 0.7cm ² and UC fragment ratio of 0.4 ± 0.1. The fixation rates for UC and LT fragments were of 18.2% and 31.8% respectively. Improved RI, UV, and PT were noted postoperatively. The mean GW and DASH scores were of 2.1 ± 2.0 and 4.3 ± 3.2 respectively. Grip strength on the operated side was of 89.5 ± 9.8% of the healthy side, and at least 90.9% of the patients achieved adequate ROM. Conclusion While volar plates are the standard treatment for intra-articular DRFs, displaced dorsal fragments can impact the outcomes. Mini dorsal incisions may aid in the fixation of UC fragments that are challenging to secure with volar plates, preserving joint health.

Keywords: bone plates; fracture fixation, internal; radius fractures; retrospective studies.

Fig. 1

The process of inclusion and exclusion of patients.

Fig. 2

The 'trick' in using the volar plate to fix a dorsal ulnar corner (UC) fragment. Securing the plate with the thumb on the plate and index finger on the dorsum of the wrist ( A ). Securing the dorsal UC fragment with a broad Weber clamp ( B,C ). Drilling under fluoroscopic guidance (D). Controlling the screws for reduction of the radial notch and undesired screw penetration of the distal radioulnar joint (DRUJ) in a skyline view with fluoroscopy ( E ).

Fig. 3

Illustration of the dorsal fragments ( A ). Measurement of the UC fragment ratio ( B ). Abbreviations: LT, Lister tubercle; UC, ulnar corner.

Fig. 4

In this example, the dorsal fragment was fixated with a screw ( A ). In this other example, the dorsal fragment could not be fixed with a screw; union was achieved from the radial side ( B ).

Fig. 5

Pre- ( A,B ) and postoperative ( C,D ) x-rays of patient number 3, who presented an additional ulnar styloid fracture and minimal UC fragment displacement (not fixed with a screw), comminution, and delayed union. The object depicted along the radial styloid is a foreign body from childhood.

Fig. 6

Pre- ( A,B ) and postoperative x-rays ( CD ) and computed tomography ( E–H ) scans of patient number 5, who presented a DRUJ dislocation preoperatively (ulnar styloid base fracture fixed with tension band wires), had no DRUJ subluxation, but had one screw affecting the index finger extensors dorsally.

Fig. 1

Processo de inclusão e exclusão de pacientes.

Fig. 2

O “truque” para usar a placa volar para a fixação do fragmento dorsal da borda cubital. Fixação da placa com o polegar na placa e o indicador no dorso do punho ( A ). Fixação do fragmento da borda cubital dorsal com pinça Weber larga ( B,C ). Perfuração sob orientação fluoroscópica ( D ). Controle dos parafusos para a redução da incisura radial e a penetração indesejada do parafuso da articulação radiocubital distal com visualização skyline à fluoroscopia ( E ).

Fig. 3

Ilustração dos fragmentos dorsais ( A ). Medida da razão de fragmentos da borda cubital (BC) ( B ). Abreviatura: TL: tubérculo de Lister.

Fig. 4

Neste exemplo, o fragmento dorsal foi fixado com parafuso ( A ). Neste outro exemplo, o fragmento dorsal não pôde ser fixado com parafuso. A união foi obtida pelo lado radial ( B ).

Fig. 5

Radiografias pré-operatórias ( A,B ) e pós-operatórias ( C,D ) do paciente de número 3, que apresentava fratura estiloide cubital, luxação mínima do fragmento da borda cubital (não fixado com parafuso), cominuição e consolidação tardia. O objeto representado ao longo do estiloide radial é um corpo estranho presente desde a infância.

Fig. 6

Radiografias pré-operatórias ( AB ), radiografias pós-operatórias ( C,D ) e tomografia computadorizada ( E–H ) do paciente de número 5, com luxação pré-operatória da articulação radiocubital distal (ARCD) (fratura da base estiloide do cúbito fixada com fios de banda de tensão). O paciente não apresentava subluxação da ARCD, mas tinha um parafuso que afetava dorsalmente os extensores do dedo indicador.