- Discussion:
- volar surface of distal part of radius
is slightly flattened, except for its distal margin, which slopes volarly to
form a prominent ridge from which volar
radiocarpal ligaments originate.
- short radiolunate ligament originates off of volar margin
of lunate facet and attaches to volar surface
of the
lunate and helps maintaining stability of the radiolunate articulation;
- ulnar volar margin of the lunate
facet slopes volarly as viewed from proximal to distal and may
not be effectively
supported by standard implants;
- volar rim of the distal part of the radius is not straight but
slopes volarly from radial to ulnar;
- ulnar aspect of the volar rim
of the radius is convex distally, forming a palmar prominence
of the lunate facet;
- volar
lunate facet extends more distally than is expected,
which makes it more difficult to achieve adequate support
with volar plate fixation;
-
fractures of lunate fossa:
- volar shearing fracture with comminution creates a functional
radiolunate ligament avulsion, which can lead to instability;
- volar aspect
of the lunate fossa bears more load than the scaphoid fossa;
- fractures
involving the volar lunate facet articular fragment can therefore be difficult to treat;
- references:
-
Loss of Fixation of the Volar Lunate Facet Fragment in Fractures of the Distal Part of the Radius
-
The volar extension of the lunate facet of the distal radius: a quantitative anatomic study.
- Indications: Limited ORIF:
- w/ limited ORIF, the distal radial metaphysis is exposed but the joint capsule remains unopened;
-
intra-articular frxs w/ > 2 millimeters of displacement;
- restoration of articular anatomy is most critical factor in obtaining a good functional result;
- risk factors for inadequate reduction include:
- dorsal comminution;
- interposition of volar soft tissues;
- tendency for dorsal displacement & dorsal angulation;
- Open Reduction and Internal Fixation
- indicated when exposure of both the metaphysis and the joint is required;
- preoperative planning:
- exam:
- if there is significant swelling the case may have to be delayed;
- patients should be examined for carpal tunnel symptoms before and after reduction;
- carpal tunnel symptoms that do not resolve following reduction will require
carpal tunnel release;
- radiographs distal radius frx:
- w/
volar Barton's frx, note whether there is more ulnar or radial sided comminution (since this can affect choice of surgical approach);
- w/ multiple small articular fragments use of a plate may not be possible (then consider
K wires &
external fixation);
-
plate position:
- plate & screws can be applied volarly when major frx fragment is displaced volarly and dorsally to act as butress when major displacement is dorsal;
- references:
-
Functional outcome of unstable distal radius fractures: ORIF with a volar fixed-angle tine plate versus external fixation.
-
Comparison of External and Percutaneous Pin Fixation with Plate Fixation for Intra-articular Distal Radial Fractures
- Surgical Approach:
- dorsal approach and fixation:
- anterior approach and fixation: (volar Barton's frx)
- internal fixation: (implants for distal radius fractures):
- external fixator:
- before incision is made, distraction & temporary external fixator will facilitate reduction of small articular fragments;
- plating techniques: (Synthes Distal Radius Plates)
- distal end of plate should be placed far enough proximally to avoid insertion of screws into articular surface;
- angle screws proximally to avoid radiocarpal joint space;
- bend plate to comform to the normal configuration of the radius;
- screws placed in diaphyseal bone will act as a butress for distal fragment;
- screws placed in distal metaphyseal fragments act more as internal sutures than rigid fixation, & these fragments may require additional K wires;
- hazards:
- frequent reports of extensor tendonitis or rupture from dorsally applied hardware;
Open reduction and internal fixation of comminuted, intraarticular fractures of the distal radius.
Intra-articular fractures of the distal end of the radius in young adults.
The surgical treatment of severe comminuted intraarticular fractures of the distal radius with the small AO external fixation device.
Immediate internal fixation of open fractures of the diaphysis of the forearm.
Open reduction and internal fixation of displaced, comminuted intra-articular fractures of the distal end of the radius.
Open treatment for displaced articular fractures of the distal radius.
Comminuted intraarticular fractures of the distal radius.
Displaced intraarticular fractures of the distal radius.
Open reduction and internal fixation of displaced, comminuted intra-articular fractures of the distal end of the radius.
An effective treatment of comminuted fractures of the distal radius.
Open treatment for displaced articular fractures of the distal radius.
Treatment of displaced articular fractures of the radius.
Open reduction and internal fixation for distal radius fractures
Factors affecting functional outcome of displaced intra-articular distal radius fractures.
The operative treatment of intraarticular fractures of the distal radius.
Intraoperative distraction in the treatment of complex nonunions of the radius.
Indications and Techniques of Open Reduction: Internal Fixation of Distal Radius Fractures.
H. Hastings, SJ Leibovic. Orthop Clin North Am. Vol 24, 1993. p 309-326.
Treatment of displaced intra-articular fractures of the distal end of the radius with plates.
BF Fitoussi MD et al. JBJS. Vol 79-A. No 9. Sep 1992. p 1303.
Surgical treatment of fractures of the distal radius with plates: a comparison of palmar and dorsal plate position
Combined Dorsal and Volar Plate Fixation of Complex Fractures of the Distal Part of the Radius.
Loss of Fixation of the Volar Lunate Facet Fragment in Fractures of the Distal Part of the Radius.
Complications following internal fixation of unstable distal radius fracture with a palmar locking-plate.
- Case Example:
