Comparison of clinical outcomes with and without volar lunate facet fragments in dorsal displaced distal radius fractures.

Hiroyuki Obata,So Kawakita,Kazuo Kaneko,Yoichi Sugiyama,Nana Nagura,Ayaka Kaneko,Kiyohito Naito,Kenji Goto

doi:10.1051/sicotj/2020047

Abstract

Introduction: Although many clinical studies about distal radius fracture (DRF) accompanied by volar lunate facet fragments (VLFF) have recently been reported, none focus on the direction of displacement of distal fragments. Many previous cases with difficulty in treating DRF with VLFF were volar-displaced fractures. Thus, the postoperative risk for re-displacement is different between volar- and dorsal-displaced fractures with VLFF. The aim of this study is to compare the outcome of dorsal-displaced fractures treated using proximal volar locking plates (PVLP) between those with VLFF and those without, in order to reconsider the indications of distal volar locking plates (DVLP) and investigate the possibility of treating dorsal-displaced DRF with VLFF using PVLP. Methods: The subjects were 122 patients with dorsal-displaced DRFs treated using PVLP (42 males and 80 females, mean age: 59.2 years old). The patients were divided into 13 patients with VLFF group and 109 patients without VLFF group, and the clinical outcomes at 12 months after surgery were compared. Results: No significant difference was noted on any evaluation between the groups. In addition, no postoperative re-displacement of VLFF was observed and bone union was confirmed. Furthermore, no osteoarthritic change was noted in all patients. Conclusions: We confirmed that surgical treatment for dorsal-displaced DRF using PVLP is possible even in cases of DRF with VLFF. In addition, DVLP is an implant with a high complication risk; therefore, it may be necessary to reconsider the use of DVLP for dorsal-displaced DRF with VLFF treatable by PVLP.

Highlights

Many studies on the treatment strategy for distal radius fracture (DRF) with volar lunate facet fragments (VLFF) have recently been reported [1,2,3,4]
Volar locking plates are often selected based on the VLFF size and to our knowledge, there has not been reported that importance to the displacement direction of distal bone fragments
The treatment strategy for DRF with VLFF focuses only on the size of VLFF and the displacement direction of fractures is not taken into consideration in many cases

Summary

Introduction

Many studies on the treatment strategy for distal radius fracture (DRF) with volar lunate facet fragments (VLFF) have recently been reported [1,2,3,4]. Volar locking plates are often selected based on the VLFF size and to our knowledge, there has not been reported that importance to the displacement direction of distal bone fragments. Many complications of DVLP, such as flexor tendon injury and crushing of VLFF, have been reported, demonstrating them to be an implant with a high risk for postoperative complications [8,9,10,11]. Reconsideration of their indications may be necessary

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