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J Wrist Surg 2022; 11(03): 238-249
DOI: 10.1055/s-0042-1748674
Special Symposium: Volar Rim Distal Radius Fracture

Anatomical and Clinical Concepts in Distal Radius Volar Ulnar Corner fractures

Wael Chiri 
1   Department of Orthopaedic Surgery, Flinders Medical Centre, Adelaide, South Australia
,
Simon BM MacLean
2   Department of Orthopaedic Surgery, Tauranga Hospital, Bay of Plenty, New Zealand
,
Jock Clarnette
1   Department of Orthopaedic Surgery, Flinders Medical Centre, Adelaide, South Australia
,
Nathan Eardley-Harris
1   Department of Orthopaedic Surgery, Flinders Medical Centre, Adelaide, South Australia
,
John White
1   Department of Orthopaedic Surgery, Flinders Medical Centre, Adelaide, South Australia
,
Gregory I. Bain
3   Division of Upper Limb and Research, Department of Orthopaedic Surgery, Flinders University and Flinders Medical Centre, Adelaide, South Australia
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Abstract

Background Volar ulnar corner fractures are a subset of distal radius fractures that can have disastrous complications if not appreciated, recognized, and appropriately managed. The volar ulnar corner of the distal radius is the “critical corner” between the radial calcar, distal ulna, and carpus and is responsible for maintaining stability while transferring force from the carpus.

Description Force transmitted from the carpus to the radial diaphysis is via the radial calcar. A breach in this area of thickened cortex may result in the collapse of the critical corner. The watershed ridge (line) is clinically important in these injuries and must be appreciated during planning and fixation. Fractures distal to the watershed ridge create an added level of complexity and associated injuries must be managed. An osteoligamentous unit comprises bone–ligament–bone construct. Volar ulnar corner fractures represent a spectrum of osteoligamentous injuries each with their own associated injuries and management techniques. The force from the initial volar ulnar corner fracture can propagate along the volar rim resulting in an occult volar ligament injury, which is a larger zone of injury than appreciated on radiographs and computerized tomography scan. These lesions are often underestimated at the time of fixation, and for this reason, we refer to them as sleeper lesions. Unfortunately, they may become unmasked once the wrist is mobilized or loaded.

Conclusions Management requires careful planning due to a relatively high rate of complications after fixation. A systematic approach to plate positioning, utilizing several fixation techniques beyond the standard volar rim plate, and utilizing fluoroscopy and/or arthroscopy is the key strategy to assist with management. In this article, we take a different view of the volar ulnar corner anatomy, applied anatomy of the region, associated injuries, and management options.

Keywords

distal radius fracture - lunate facet - carpal instability - osteoligamentous unit - watershed line - watershed ridge - volar ulnar corner - volar rim


Publikationsverlauf

Eingereicht: 21. September 2021

Angenommen: 08. März 2022

Artikel online veröffentlicht:
12. Juli 2022

© 2022. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

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