Jnl Wrist Surg 2016; 05(01): 017-021
DOI: 10.1055/s-0035-1570745
Special Focus Section: Volar and Dorsal Rim Fractures of the Distal Radius
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Prevent Collapse and Salvage Failures of the Volar Rim of the Distal Radius

Jorge L. Orbay
1  The Miami Hand and Upper Extremity Institute, Miami, Florida
,
Francisco Rubio
1  The Miami Hand and Upper Extremity Institute, Miami, Florida
,
Lauren L. Vernon
1  The Miami Hand and Upper Extremity Institute, Miami, Florida
› Author Affiliations
Further Information

Publication History

04 December 2015

08 December 2015

Publication Date:
12 January 2016 (online)

Abstract

Background Articular fractures of the distal radius may include a small fragment from the volar margin of the lunate fossa: volar marginal fragments (VMFs); these fragments are prone to loss of fixation and avascular necrosis, and often result in wrist subluxation. We present our experience managing acute and delayed VMFs. The first is treated using a hook plate extension to a volar locking plate and the latter using a volar opening wedge osteotomy to redistribute loads on the remaining articular surface.

Materials and Methods We retrospectively reviewed the records of all patients treated at our facility with a hook plate extension for a VMF and for patients treated with a volar opening wedge osteotomy. Medical charts were examined for complications and functional results.

Technique A hook plate extension was used to fix the VMF when plate buttressing was insufficient. For patients who presented a collapsed and reabsorbed VMF, a volar opening wedge osteotomy was used to reorient the articular surface, restoring joint stability.

Results The hook plate extension was successful in managing 19 of the 21 acute VMFs. The volar opening wedge osteotomy provided concentric reduction and improved pain and motion in all treated patients.

Conclusion We demonstrated that hook plate fixation of the VMF is an effective means of fixing the acute VMF and that a volar opening wedge osteotomy can be used to salvage a distal radius fracture with a collapsed VMF.