Article ID: JNMS.2020_87-106
Background: Standard volar plating of distal radius fractures may not adequately fixate the volar lunate facet (VLF) fragment, leading to volar carpal subluxation. In this study, we hypothesized that the size of the VLF fragments distal to the watershed line might affect the reduction loss after distally placed volar locking plate fixation for intra-articular distal radius fracture, and aimed to prove that small displaced VLF fragments was a risk factor in causing reduction loss.
Methods: Twenty-seven hands in 27 patients with intra-articular distal radius fractures with VLF fragments distal to the watershed line were treated using Acu-Loc 2 volar distal radius locking plate fixation.
Results: At final follow-up, the mean Mayo Performance Score was 90.9 and the mean Quick Disabilities of Arm, Shoulder and Hand score was 13.6. On radiography, 5 patients had reduction loss of > 2 mm in ulnar variance from immediately postoperatively to final follow-up (group 1), while 27 had no reduction loss (group 2). Compared with group 2, the VLF fragment in group 1 had significantly smaller mean longitudinal, transverse, and anteroposterior lengths, and joint surface area. Three-dimensional computed tomography revealed that the fracture patterns of the radiocarpal and distal radioulnar joints in group 1 were mainly volar displaced VLF fragments.
Conclusions: Distally placed volar locking plate fixation effectively treats intra-articular distal radius fractures with VLF fragments distal to the watershed line by stabilizing the fragments. However, small displaced VLF fragments may increase the risk of reduction loss in ulnar variance.
