Anatomy of the Watershed Line of the Distal Radius

Fracture of the distal radius is the most common fracture in the upper extremity. There are several variations in distal radius fracture, that is, dorsal (Colles) or volar (Smith) extra-articular fracture, intra-articular fracture with either dorsal simple fragment (dorsal Barton) or volar fragment (volar Barton), volar or dorsal rim fracture, and comminuted complex intra-articular fracture. All of these fractures may be closed or open. These variations of the distal radius fracture may also require different fixation devices such as a plating, external fixator, K-wires, or variety of screws, although volar locking plate (VLP) for every fracture seems to be the recent trend.

Since 2002, development of the VLP technique for distal radius fracture has been popularized by Dr. Jorge Orbay with great vigor. Successful reduction of the comminuted fragment of the distal radius can be achieved as long as the surgeon possesses adequate knowledge about the volar surface of the distal radius, including variations. The watershed line, which was also advocated by Dr. Orbay, is considered important to fix the intra-articular distal radius fracture. Anatomical knowledge of distal radius, especially the watershed line, is quite significant. In my opinion, however, every device has disadvantages, and it is pertinent to remember that we still have other options, such as external fixator to fix the comminuted intra-articular distal radius fracture.

This issue includes the “Special Review,” which is the “Bony anatomy around the watershed line of the distal radius” described by Dr. Kenny Tay. This review sheds light on the anatomical knowledge of the volar surface of the distal radius, including the watershed line, its width and height; more importantly, it aids in the understanding of the angle subtended between pronator fossa and radial styloid, in order to not penetrate the joint surface by screw of the locking plate. Insightful papers focusing on wrist topics such as the arthroscopic treatment for Kienböck disease, triangular fibrocartilage complex (TFCC) lesions, carpal instability, total wrist arthroplasty and carpometacarpal (CMC) arthrosis, as well as interesting case reports, procedures and denervation technique papers, are also included in this issue. Do not miss it.

Publication History

Article published online:
02 August 2021