Abstract
BackgroundAlthough distal radius fractures (DRFs) are clinically common, intra-articular DRFs accompanied by dorsally displaced free fragments are much less so. At present, it is very difficult to fix and stabilize the intra-articular distal radius fractures accompanying dorsally displaced free fragments with a plate. Our aim was to investigate the clinical effect of DRFs with distally displaced dorsal free mass treated with distal volaris radius (DVR) combined with turning of the radius via the distal palmar approach.MethodsFrom 2015 to 2019, 25 patients with intra-articular distal radius fractures associated with dorsally displaced free fragments were selected and treated with distal volaris radius (DVR) combined with turning of the radius via the distal palmar approach. This study involved 14 males and 11 females, with an average age of 34.5 years (ranging from 21 to 50 years). The mean follow-up period was 16.5 months (ranging from 12 to 22 months). The dorsal displacement of the free fragments was analyzed by X-ray and three-dimensional computed tomography, allowing characterization of postoperative recovery effects by radial height, volar tilt and radial inclination. For the follow-up, we evaluated effects of the surgery by analyzing range of motion (ROM); Modified Mayo Wrist Score (MMWS); and Disabilities of Arm, Shoulder and Hand (DASH) score. Postoperative wound recovery and complications were also monitored to evaluate the clinical therapeutic effects of the surgical procedures.ResultsX-ray showed that all patients showed reduced fractures, well-healed wounds and recovered function with no obvious complications. Based on the follow-up, patients had a mean radial height of 10.5 mm (ranging from 8.1 to 12.6 mm), mean MMWS of 78.8° (ranging from 61° to 90°), mean DASH score of 16.25 (ranging from 11 to 21), mean ROM for volar flexion of 76.5° (ranging from 62° to 81°), mean ROM for dorsiflexion of 77.1° (ranging from 59 to 83) and mean VAS score of 1.4 (ranging from 1 to 3).ConclusionTreatment of the intra-articular distal radius fractures accompanying dorsally displaced free fragments with turning of the radius and the DVR plate system via the distal palmar approach is effective and has no obvious complications.
Highlights
Distal radius fractures (DRFs) are clinically common, intra-articular distal radius fractures (DRFs) accompanied by dorsally displaced free fragments are much less so
High-energy injuries often lead to DRFs with dorsally or volarly displaced free fracture fragments; the incidence of intra-articular distal radius fractures accompanying dorsally displaced free fragments is very rare, making volarly locking plate fixation difficult
The purpose of this study is to summarize the surgical method of the distal palmar approach combined with distal volaris radius (DVR) plate fixation after radius turnover for the treatment of intra-articular distal radius fractures accompanied by dorsally displaced free fragments, as well as to evaluate the therapeutic effects of this technique
Summary
Distal radius fractures (DRFs) are clinically common, intra-articular DRFs accompanied by dorsally displaced free fragments are much less so. It is very difficult to fix and stabilize the intra-articular distal radius fractures accompanying dorsally displaced free fragments with a plate. High-energy injuries often lead to DRFs with dorsally or volarly displaced free fracture fragments; the incidence of intra-articular distal radius fractures accompanying dorsally displaced free fragments is very rare, making volarly locking plate fixation difficult. This kind of fracture belongs to the class of intra-articular fractures, which require anatomical reduction and firm fixation. No current treatments are sufficient to adequately resolve these fractures, making them a challenge for orthopedic surgeons [5, 6]
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