gms | German Medical Science

Objectives/Interrogation: Fractures of the distal Radius are very common, and they frequently are intra-articular. In most of these cases surgical treatment is required and an adequate fixation is achieved with the current implants. Nevertheless there is an unusual pattern, determined by the presence of extremely distal fragments, where traditional osteosynthesis could not be useful.

The goal of this study is to analyze this distal radius fracture pattern that has some distinctive specific fragments and might be treated in a different way from the standard distal radius articular lesions.

Methods: X-rays and CT scans were used to retrospectively study 1019 distal radius fractures operated in our Hospital between January 2012 and December 2017.

Our inclusion criteria were:

• Radial Styloid fracture
• Avulsion of the ventral and/or dorsal rims of the distal radius
• A very distal articular fragment of the lunate and/or scaphoid fossa of the radius, including a shell of subchondral bone not more than 3 mm thick.

We excluded:

• Patients younger than 18 years-old
• Patients with radiocarpal dislocation

The resulting preoperative X-rays and CT scans were compared looking for a common fracture pattern.

Postoperative studies were evaluated to review the type of fixation used.

Results and Conclusions: Ten patients among 1019 distal radius fractures met the inclusion criteria (1%).

All patients but one were male. Mean age was 39 years old.

In all the cases the 3D CT scans clearly defined the fracture fragments, seldom identified with only plain X-rays. All the patients that met inclusion criteria had an associated fragment of the lunate and /or scaphoid fossa and its subchondral bone, not thicker than 3 mm.

Both Radial Styloid fractures and dorsal or volar avulsion solid fragments were fixed with cannulated headless 2.3 screws. Smaller avulsion or comminuted avulsion fragments were fixed with bone sutures or bone anchors. Dorsal comminution was buttressed with 2.0 or smaller plates. None of the fractures was feasible for standard volar locking plating.

We describe a pattern of distal radius avulsion fracture without dislocation, which is associated with subchondral distal fracture of the lunate and/or scaphoid fossa.

This pattern of fracture affected more frequently young males with high energy injuries.

It is probably necessary to develop new types of osteosynthesis materials to efficiently fix these very distal small fragments, since it is difficult to achieve this with the existing osteosynthesis.