Abstract
Introduction: Loss of reduction after operative fixation of volarly unstable distal radius fractures with a volar lunate facet fragment (VLF) is considered problematic because it results in carpal subluxation or dislocation and subsequent impaired function. We hypothesized that the indicator of loss of reduction of the VLF after fixation is plate coverage of the bony fragment. We investigated the relationship between the plate coverage of the VLF and loss of reduction after fixation, and calculated the plate coverage that was associated with failure of fixation of the VLF.Materials and methods: We conducted a retrospective review. We included patients with surgically treated volarly unstable distal radius fractures with VLF with a volar locking plate who had a minimum follow-up of 6 months. A total of 33 patients (35 wrists) met criteria for inclusion into the study. The patients were divided into a displacement group and a non-displacement group. We calculated and compared longitudinal dimension and plate coverage of the VLF between the two groups to reveal the risk factors for loss of reduction.Results: At final follow-up, 25 fractures maintained radiographic alignment and 10 (28.6%) lost reduction. Univariate analysis between the two groups showed that plate coverage against the transverse and longitudinal dimension of the VLF was correlated with loss of reduction after operative fixation. In multivariate logistic regression analysis, only plate coverage against the longitudinal dimension of the VLF remained a significant predictor of failure. With 64.7% as the cut-off point for plate coverage against the longitudinal dimension of the VLF, the sensitivity and specificity of the prediction were 96% and 80%, respectively.Conclusion: The predictor of loss of reduction after fixation of volarly unstable distal radius fractures with a VLF was plate coverage against the longitudinal dimension of the VLF.
Highlights
Loss of reduction after operative fixation of volarlly unstable distal radius fractures with a volar lunate facet fragment (VLF) is considered problematic because it results in carpal subluxation or dislocation and subsequent impaired function, pain, limitation of range of motion, and posttraumatic arthritis [1, 2]
Univariate analysis between the two groups showed that plate coverage against the transverse dimension of the VLF and plate coverage against the longitudinal dimension of the VLF were correlated with loss of reduction after operative fixation (p < 0.001, p < 0.001, respectively)
In multivariate logistic regression analysis for plate coverage against the transverse and longitudinal dimension of the VLF, after controlling for age, sex, and longitudinal dimension of the VLF, only plate coverage against the longitudinal dimension of the VLF remained a significant predictor of failure (p = 0.029) (Table 3)
Summary
Loss of reduction after operative fixation of volarlly unstable distal radius fractures with a volar lunate facet fragment (VLF) is considered problematic because it results in carpal subluxation or dislocation and subsequent impaired function, pain, limitation of range of motion, and posttraumatic arthritis [1, 2]. Previous studies have reported that the incidence of failure of fixation is 4–13% [2,3,4]. Because the volar aspect of the lunate fossa bears more load than the scaphoid fossa when the wrist is in a position of function, a strong load is applied to the VLF. The short radiolunate ligament and volar distal radioulnar ligament, which stabilize the radiocarpal joint, attach to the VLF, so strong traction forces are applied to the fragment with motion of the wrist [1].
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