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McCarty JC, Cross RE, Laane CLE, Hoftiezer YAJ, Gavagnin A, Regazzoni P, Fernandez Dell'Oca A, Jupiter JB, Bhashyam AR. Teardrop Alignment Changes After Volar Locking Plate Fixation of Distal Radius Fractures With Volar Ulnar Fragments. Hand (N Y) 2024:15589447241233762. [PMID: 38439630 DOI: 10.1177/15589447241233762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Abstract
BACKGROUND We assessed factors associated with change in radiographic teardrop angle following volar locking plate (VLP) fixation of volarly displaced intra-articular distal radius fractures with volar ulnar fragments (VUF) within the ICUC database. The primary outcome was change in radiographic alignment on follow-up imaging, defined as a change in teardrop angle from intra-operative fluoroscopy greater than 5°. METHODS Patients with distal radius fractures treated with a VLP within the ICUC database, an international collaborative and publicly available dataset, were identified. The primary outcome was volar rim loss of reduction on follow-up imaging, defined as a change in radiographic alignment from intra-operative fluoroscopy, teardrop angle less than 50°, or loss of normal radiocarpal alignment. Secondary outcomes were final range of motion (ROM) of the affected extremity. Radiographic Soong classification was used to grade plate position. Descriptive statistics were used to assess variables' distributions. A Random Forest supervised machine learning algorithm was used to classify variable importance for predicting the primary outcome. Traditional descriptive statistics were used to compare patient, fracture, and treatment characteristics with volar rim loss of reduction. Volar rim loss of reduction and final ROM in degrees and as compared with contralateral unaffected limb were also assessed. RESULTS Fifty patients with volarly displaced, intra-articular distal radius fractures treated with a VLP were identified. Six patients were observed to have a volar rim loss of reduction, but none required reoperation. Volar ulnar fragment size, Soong grade 0, and postfixation axial plate position in relation to the sigmoid notch were significantly associated (P < .05) with volar rim loss of reduction. All cases of volar rim loss of reduction occurred when VUF was 10.8 mm or less. CONCLUSIONS The size of the VUF was the most important variable for predicting volar rim loss of reduction followed by postfixation plate position in an axial position to the sigmoid notch and the number of volar fragments in the Random Forest machine learning algorithm. There were no significant differences in ROM between patients with volar ulnar escape and those without.
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Affiliation(s)
- Justin C McCarty
- Hand & Arm Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, USA
- Department of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Boston, USA
| | - Rachel E Cross
- Hand & Arm Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, USA
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Charlotte L E Laane
- Hand & Arm Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, USA
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Yannick Albert J Hoftiezer
- Hand & Arm Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, USA
- Department of Plastic, Reconstructive and Hand Surgery, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Aquiles Gavagnin
- Department of Orthopedics, Hospital Britanico Montevideo, Uruguay
| | | | | | - Jesse B Jupiter
- Hand & Arm Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, USA
| | - Abhiram R Bhashyam
- Hand & Arm Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, USA
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Adams AJ, Ilyas AM. Management of Lunate Facet Escape after Distal Radius Fracture Volar Plating: Surgical Technique. J Hand Microsurg 2024; 16:100018. [PMID: 38854386 PMCID: PMC11127541 DOI: 10.1055/s-0043-1761220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/15/2023] Open
Abstract
Fractures involving the lunate facet of the distal radius (commonly called the volar ulnar corner or "critical corner") are often difficult to recognize radiographically. "Lunate facet escape" refers to the displacement of this fragment after attempted distal radius fracture closed or open reduction methods. Lunate facet escape can have severe consequences including carpal collapse with pain, instability, and arthritis. Challenges to lunate facet fixation include irregular cortical contour that makes plate fixation difficult, as well as deforming forces by inserting structures. The goal of the management of a distal radius fracture with lunate facet involvement is first identification, then adequate stabilization until osseous healing occurs. However, subsequent lunate facet escape can pose a challenging clinical and surgical dilemma. Here we discuss our preferred approach to treat lunate facet escape after distal radius fracture volar locking plating failure.
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Affiliation(s)
- Alexander J. Adams
- Department of Orthopedic Surgery, Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania, United States
| | - Asif M. Ilyas
- Department of Orthopedic Surgery, Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania, United States
- Rothman Opioid Foundation, Philadelphia, Pennsylvania, United States
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Mitsuzawa S, Takeuchi H, Tsukamoto Y, Yamashita S, Ota S, Onishi E, Yasuda T. Risk Factors for the Incidence of the Volar Lunate Facet Fragments in Distal Radius Fractures. J Wrist Surg 2023; 12:353-358. [PMID: 37564612 PMCID: PMC10411066 DOI: 10.1055/s-0042-1760125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 11/18/2022] [Indexed: 01/13/2023]
Abstract
Background The volar lip of the distal radius is the key structure for wrist joint stability. Rigid fixation of the volar lunate facet (VLF) fragment is difficult because of its unique anatomy, and a high rate of postoperative displacement was demonstrated. Purposes The aim of the study is to identify risk factors for VLF in distal radius fractures (DRFs) and to reconsider the important point for primary fixation. Patients and Methods One hundred fifty-five patients who underwent open reduction and internal fixation for an DRF were included and classified into one of the following two groups: VLF(+)or VLF(-). Demographic data, including age, sex, body mass index (BMI), laterality, trauma mechanism, and AO Foundation/Orthopaedic Trauma Association (AO/OTA) classification were recorded. Several parameters were investigated using wrist radiographs of the uninjured side and computed tomography scans of the injured side. Univariate and multivariate logistic regression analyses were performed to evaluate the risk factors for VLF. Results There were 25 patients in the VLF(+) group and 130 patients in the VLF(-) group. The incidence of VLF was 16.1%. The VLF(+) group tended to have a higher BMI and higher energy trauma mechanism. The odds ratio for the sigmoid notch angle (SNA), volar tilt (VT), and lunate facet curvature radius (LFCR) were 0.84, 1.32, and 0.70, respectively, with multivariate analysis, which was significant. A smaller SNA, larger VT, and smaller LFCR are potential risk factors for VLF. Conclusion Over-reduction of the VT at primary fixation should be avoided because it could place an excess burden on the VLF and cause subsequent postoperative fixation failure and volar carpal subluxation. Level of Evidence IV.
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Affiliation(s)
- Sadaki Mitsuzawa
- Department of Orthopaedic Surgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Hisataka Takeuchi
- Department of Orthopaedic Surgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Yoshihiro Tsukamoto
- Department of Orthopaedic Surgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Shinnosuke Yamashita
- Department of Orthopaedic Surgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Satoshi Ota
- Department of Orthopaedic Surgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Eijiro Onishi
- Department of Orthopaedic Surgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Tadashi Yasuda
- Department of Orthopaedic Surgery, Kobe City Medical Center General Hospital, Kobe, Japan
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Orbay MC, Orbay JL. Classification and Management of Failed Fixation of the Volar Marginal Fragment in Distal Radius Fractures. J Wrist Surg 2022; 11:219-223. [PMID: 35837586 PMCID: PMC9276060 DOI: 10.1055/s-0041-1735885] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 08/02/2021] [Indexed: 12/15/2022]
Abstract
Greater understanding of specific fracture patterns following distal radius fractures has arisen with the advent of volar plating. The volar marginal fragment (VMF) is a small peripheral piece of bone which is critical to carpal stability. Failure to achieve good fixation of the VMF can result in volar subluxation of the carpus and distal radioulnar joint instability. Due to its small, distal nature, this fragment can be easily missed and difficult to fix. Loss of reduction of the VMF following operative fixation presents specific challenges and surgical considerations dictated by patient characteristics and timing. Our goal of this review is to present a classification system for these failed VMFs which can help guide surgical treatment as well as expected outcomes.
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Extended Flexor Carpi Radialis Approach. J Orthop Trauma 2021; 35:s1-s5. [PMID: 34415874 DOI: 10.1097/bot.0000000000002207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/08/2021] [Indexed: 02/02/2023]
Abstract
Level V-Expert Opinion.
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