Article
Fixation of Dorsal Ulnar Corner Fractures of the Distal Radius Through an Anterior Approach A Prospective Study with CT Documentation
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Authors
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Jesse Jupiter
- Massachusetts General Hospital, Harvard Medical School, Boston, United States
| Published: | February 6, 2020 |
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Outline
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Objectives/Interrogation: Articular fractures of the distal radius involving a displaced dorsal ulnar corner are problematic and may impact both radiocarpal and/or distal radioulnar joints. Operative treatment may require both volar and dorsal approaches. In this prospective single surgeon study approaching all fractures through only an anterior incision, we have documented the accuracy of reduction comparing preoperative and postoperative axial CT scans and clinical documentation at 12months post surgery.
Methods: 61 patients with an intraarticular distal radius fracture featuring a splint lunate facet or isolated dorsal lunate facet were treated operatively within 10 days of injury. The surgical approach was the standard FCR exposure without additional release of the tendon. The fracture was reduced using ligamentotaxis, manual manipulation, and a specific radiolucent bone reduction clamp over the dorsal lunate facet. The fixation in each case was done with a 2.4 mm Variable Angle Distal Radius Plate System ®.
Pre and early postoperative axial and sagittal CT scans were used to measure the fracture gap at the sigmoid notch, intraarticular step off, degree of ulnar subluxation, and any screw penetration into the joint.
Results and Conclusions: The CT scans revealed a significant correction of the fracture gap from a mean 2.0 mm pre-op to a mean of 0.48 mm postoperatively. The mean fracture step was corrected from 1.4 mm to 0 mm. The mean ulnar subluxation was corrected in each instance with minimal residual subluxation in a limited number of patients. Grade I arthritis changes were found in 14 patients and grade II in 7.
Clincally at an average follow up or 12.6 months, the mean range of motion compared to the opposite wrist was 95% of flexion; 92% of extension; 99% of both supination and pronation.
Using a standard volar approach with the important inclusion of a radiolucent reduction clamp which puts direct pressure over the dorsal lunate facet, we have demonstrated successful reduction of the articular fracture including the sigmoid notch.
