Size and stabilization of the dorsoulnar fragment in AO C3-type distal radius fractures |
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| Institution: | 1. Department of Orthopaedic Surgery, Osaka General Hospital of West Japan Railway Company, 1-2-22 Matsuzakicho, Abeno-ku, Osaka 545-0053, Japan;2. Department of Orthopaedic Surgery, Seikeikai Hospital, 1-1-1 Minamiyasuicho, Sakai-ku, Sakai, Osaka 590-0064, Japan;3. Department of Orthopaedic Surgery, Higashisumiyoshi Morimoto Hospital, 3-2-66 Takaai, Higashisumiyoshi-ku, Osaka 546-0014, Japan;1. Oklahoma State University Center for Health Sciences, Tulsa, OK, United States;2. Orthopaedic & Trauma Services of Oklahoma, Tulsa, OK, United States;3. Oklahoma State University Medical Center - Department of Orthopaedics, Tulsa, OK, United States;1. Department of Orthopedic Surgery, KK Women’s and Children’s Hospital, Singapore;2. National University of Singapore, Singapore;1. Department of Orthopaedic Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States;2. Department of Epidemiology, Dartmouth College, Hanover, NH, United States;3. Quantitative Biomedical Sciences, Dartmouth College, Hanover, NH, United States;1. London Health Sciences Center, Canada;2. University of Southern California, United States;1. Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway;2. Department of Clinical Medicine, University of Bergen, Bergen, Norway |
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| Abstract: | IntroductionVolar locking plate (VLP) fixation has become the gold-standard treatment for distal radius fractures (DRFs). Especially, internal fixation of the volar lunate facet fragment is essential for the treatment of AO C3-type DRFs. On the other hand, the necessity of the fixation of the dorsal lunate facet fragment (dorsoulnar fragment) remains unclear. The purpose of the present study was to measure three-dimensionally the size of the dorsoulnar fragments in AO C3-type DRFs using computed tomography (CT) images in detail, and to reveal relationships of the size and stabilization of the dorsoulnar fragment with postoperative fracture displacement after VLP fixation.Materials and methodsWe retrospectively reviewed the 101 consecutive Japanese patients who underwent surgical treatment for AO C3-type distal radius fractures. If patient had dorsoulnar fragment, the three-dimensional size of this fragment and the occupying ratio to the radiocarpal joint (RCJ) and the distal radioulnar joint (DRUJ) were anatomically evaluated using the preoperative CT images. In addition, we investigated the relationship of the size and stabilization of the dorsoulnar fragment with fracture displacement after VLP fixation. We statistically compared the size parameters and occupying ratio of the dorsoulnar fragment between the displaced group and the stable groups using a two-tailed t-test. We also statistically compared the numbers of screws inserted into the dorsoulnar fragments between the displaced and stable groups using a chi-square test.ResultsThe mean dorsoulnar fragment size was 9.4 mm × 7.9 mm × 11.0 mm and the occupying ratio to the DRUJ and RCJ was 50% and 10%, respectively. The number of patients treated with volar locking plate fixation was 77, of which 12 patients had postoperative displacements. Although the size of the dorsoulnar fragment was not associated with postoperative displacement, stabilization following screw insertion into the dorsoulnar fragment was significantly associated with displacement.ConclusionStabilization of the dorsoulnar fragment with at least one screw of the volar locking plate was necessary to prevent postoperative fracture displacement regardless of dorsoulnar fragment size in AO C3-type distal radius fractures. |
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| Keywords: | Distal radius fracture Volar locking plate Lunate facet Displacement Rim Dorsoulnar fragment |
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