Subscribe to RSS
DOI: 10.1055/s-0035-1571184
The Effect of Displaced Dorsal Rim Fragment in a Distal Radius Fracture
Publication History
09 December 2015
20 December 2015
Publication Date:
06 January 2016 (online)
![](https://www.thieme-connect.de/media/jws/201601/lookinside/thumbnails/10-1055-s-0035-1571184_1500099sf-1.jpg)
Abstract
Background In intra-articular fracture of distal radius, the intra-articular fragments can be divided into some specific fragments. In particular, the poor outcomes have been well documented for reduction loss of the volar lunate facet, but the effect of a displaced dorsal rim fracture has rarely been addressed.
Materials and Methods The records of 26 patients with dorsal rim fragment displaced by more than 2 mm after volar locking plate (VLP) fixation for a dorsally displaced distal radius fracture (DRF) treated from March 2006 to March 2009 were retrospectively reviewed. Clinical assessments including grip strengths, wrist range of motions, and Disabilities of Arm, Shoulder, and Hand (DASH) scores were performed at 12 months postoperatively. Widths of the distal ends of dorsal rims were determined by preoperative computed tomography (CT). Dorsal rim fragment displacements were measured in immediate postoperative plain lateral radiographs. Radial inclination, volar tilt, and ulnar variance were measured on immediate postoperative wrist radiographs. Arthritic changes of radiocarpal joints were graded using radiographs obtained at 12 months postoperatively.
Description of Technique DRFs were fixed using a VLP in the usual manner. Although DRF displacement was noticed after plate fixation, no further procedure was performed. The sizes of articular portions of dorsal rim fragments were measured arthroscopically in 5 of the 26 patients at the time of plate fixation.
Results At 12 months postoperatively, mean grip strength, wrist flexion arc, and mean wrist extension arc were 86 ± 13, 87 ± 11, and 91 ± 10%, respectively, of contralateral sides. Mean forearm supination and pronation were 96 ± 8 and 99 ± 5%, respectively, of contralateral sides. Mean DASH score was 11 ± 10 points. Preoperatively, mean width of the distal end of dorsal rim fragments and mean displacements of dorsal rim fragments were 2.0 ± 0.6 and 3.0 ± 0.9 mm, respectively. Mean width of the articular portions of dorsal rim fragment by arthroscopic examination was 1.0 ± 0.4 mm. Mean radial inclination was 21 ± 4.8 degrees, mean volar angulation was 4.8 ± 3.9 degrees, and mean ulnar variance was 0.6 ± 1.8 mm at immediate postoperatively. Two patients showed grade I arthritic changes at 12 months postoperatively.
Conclusions The articular portions of dorsal rim fragments measured arthroscopically were smaller than determined by CT. Furthermore, the study shows that displaced dorsal rim fragments in dorsally displaced DRFs treated by VLP do not adversely affect wrist clinical outcomes.
-
References
- 1 Kim JK, Park SD. Outcomes after volar plate fixation of low-grade open and closed distal radius fractures are similar. Clin Orthop Relat Res 2013; 471 (6) 2030-2035
- 2 Kim JK, Cho SW. The effects of a displaced dorsal rim fracture on outcomes after volar plate fixation of a distal radius fracture. Injury 2012; 43 (2) 143-146
- 3 Orbay J, Badia A, Khoury RK, Gonzalez E, Indriago I. Volar fixed-angle fixation of distal radius fractures: the DVR plate. Tech Hand Up Extrem Surg 2004; 8 (3) 142-148
- 4 Makhni EC, Taghinia A, Ewald T, Zurakowski D, Day CS. Comminution of the dorsal metaphysis and its effects on the radiographic outcomes of distal radius fractures. J Hand Surg Eur Vol 2010; 35 (8) 652-658
- 5 Tanabe K, Nakajima T, Sogo E, Denno K, Horiki M, Nakagawa R. Intra-articular fractures of the distal radius evaluated by computed tomography. J Hand Surg Am 2011; 36 (11) 1798-1803
- 6 Medoff RJ. Essential radiographic evaluation for distal radius fractures. Hand Clin 2005; 21 (3) 279-288
- 7 Knirk JL, Jupiter JB. Intra-articular fractures of the distal end of the radius in young adults. J Bone Joint Surg Am 1986; 68 (5) 647-659
- 8 Kim JK, Koh YD, Kook SH. Effect of calcium phosphate bone cement augmentation on volar plate fixation of unstable distal radial fractures in the elderly. J Bone Joint Surg Am 2011; 93 (7) 609-614
- 9 Orbay JL, Fernandez DL. Volar fixation for dorsally displaced fractures of the distal radius: a preliminary report. J Hand Surg Am 2002; 27 (2) 205-215
- 10 Mattila VM, Huttunen TT, Sillanpää P, Niemi S, Pihlajamäki H, Kannus P. Significant change in the surgical treatment of distal radius fractures: a nationwide study between 1998 and 2008 in Finland. J Trauma 2011; 71 (4) 939-942 , discussion 942–943
- 11 Wilcke MK, Hammarberg H, Adolphson PY. Epidemiology and changed surgical treatment methods for fractures of the distal radius: a registry analysis of 42,583 patients in Stockholm County, Sweden, 2004–2010. Acta Orthop 2013; 84 (3) 292-296
- 12 Lee JY, Lim JY, Oh JH, Ko YM. Cross-cultural adaptation and clinical evaluation of a Korean version of the disabilities of arm, shoulder, and hand outcome questionnaire (K-DASH). J Shoulder Elbow Surg 2008; 17 (4) 570-574
- 13 Crosby CA, Wehbé MA, Mawr B. Hand strength: normative values. J Hand Surg Am 1994; 19 (4) 665-670
- 14 Petersen P, Petrick M, Connor H, Conklin D. Grip strength and hand dominance: challenging the 10% rule. Am J Occup Ther 1989; 43 (7) 444-447
- 15 Haus BM, Jupiter JB. Intra-articular fractures of the distal end of the radius in young adults: reexamined as evidence-based and outcomes medicine. J Bone Joint Surg Am 2009; 91 (12) 2984-2991
- 16 Harness NG, Jupiter JB, Orbay JL, Raskin KB, Fernandez DL. Loss of fixation of the volar lunate facet fragment in fractures of the distal part of the radius. J Bone Joint Surg Am 2004; 86-A (9) 1900-1908
- 17 Ruch DS, Wray III WH, Papadonikolakis A, Richard MJ, Leversedge FJ, Goldner RD. Corrective osteotomy for isolated malunion of the palmar lunate facet in distal radius fractures. J Hand Surg Am 2010; 35 (11) 1779-1786
- 18 Wiesler ER, Chloros GD, Lucas RM, Kuzma GR. Arthroscopic management of volar lunate facet fractures of the distal radius. Tech Hand Up Extrem Surg 2006; 10 (3) 139-144
- 19 Harreld KL, Apel P, Koman LA, Li Z. Lunate-lunate facet ratio and variance to predict articular gap after distal radius fracture. J Hand Surg Am 2009; 34 (9) 1625-1632
- 20 Ikeda K, Osamura N, Tada K. Fixation of an ulnodorsal fragment when treating an intra-articular fracture in the distal radius. Hand Surg 2014; 19 (1) 139-144
- 21 Lee JI, Cho JH, Lee SJ. The effects of the Frag-Loc(®) compression screw on distal radius fracture with a displaced dorsoulnar fragment. Arch Orthop Trauma Surg 2015; 135 (9) 1315-1321
- 22 Anderson DD, Deshpande BR, Daniel TE, Baratz ME. A three-dimensional finite element model of the radiocarpal joint: distal radius fracture step-off and stress transfer. Iowa Orthop J 2005; 25: 108-117
- 23 Anderson DD, Bell AL, Gaffney MB, Imbriglia JE. Contact stress distributions in malreduced intraarticular distal radius fractures. J Orthop Trauma 1996; 10 (5) 331-337
- 24 Baratz ME, Des Jardins Jd, Anderson DD, Imbriglia JE. Displaced intra-articular fractures of the distal radius: the effect of fracture displacement on contact stresses in a cadaver model. J Hand Surg Am 1996; 21 (2) 183-188
- 25 Wagner Jr WF, Tencer AF, Kiser P, Trumble TE. Effects of intra-articular distal radius depression on wrist joint contact characteristics. J Hand Surg Am 1996; 21 (4) 554-560