Title: Fixation of Dorsal Ulnar Corner Fractures of the Distal Radius Through an Anterior Approach—A Prospective Study with CT Documentation
Presenter/Contact Person:
Jyoti Sharma
Department of Orthopaedic Surgery, Hand Service
Yawkey Center for Outpatient Care
Second Floor, Suite 2C
55 Fruit Street
Boston, MA 02114
Tel: 617-726-4700
Fixation of Dorsal Ulnar Corner Fractures of the Distal Radius Through an Anterior Approach—A Prospective Study with CT Documentation
Mariana Josefina Alvarez, Amir Kachooei, Mariana Fernandez, Alberto Fernandez, Jesse Jupiter
Purpose
Articular fractures of the distal radius involving a displaced dorsal ulnar corner are problematic and may impact both radiocarpal and/or distal radioulnar joints. Operative treatment may require both volar and dorsal approaches. In this prospective single surgeon study approaching all fractures through only an anterior incision, we have documented the accuracy of reduction comparing preoperative and postoperative axial CT scans and clinical documentation at 12months post surgery.
Methods
61 patients with an intraarticular distal radius fracture featuring a splint lunate facet or isolated dorsal lunate facet were treated operatively within 10 days of injury. The surgical approach was the standard FCR exposure without additional release of the tendon. The fracture was reduced using ligamentotaxis, manual manipulation, and a specific radiolucent bone reduction clamp over the dorsal lunate facet. The fixation in each case was done with a 2.4mm Variable Angle Distal Radius Plate System ®.
Pre and early postoperative axial and sagittal CT scans were used to measure the fracture gap at the sigmoid notch, intraarticular step off, degree of ulnar subluxation, and any screw penetration into the joint.
Results
The CT scans revealed a significant correction of the fracture gap from a mean 2.omm pre-op to a mean of 0.48 mm postoperatively. The mean fracture step was corrected from 1.4mm to 0mm. The mean ulnar subluxation was corrected in each instance with minimal residual subluxation in a limited number of patients. Grade I arthritis changes were found in 14 patients and grade II in 7.
Clinically at an average follow up of 12.6 months, the mean range of motion compared to the opposite wrist was 95% of flexion, 92% of extension, 99% of both supination and pronation.
Conclusion
Using a standard volar approach with the important inclusion of a radiolucent reduction clamp which puts direct pressure over the dorsal lunate facet, we have demonstrated successful reduction of the articular fracture including the sigmoid notch.
Figure 1. Pre and post fixation CT scans demonstrating fracture gap correction.