Osteochondrocapsular Suture, An Adjunct to Volar Locking Plate Treating Dorsally Dislocated Volar Rim Fracture Type of Distal Radius Fracture

It is challenging to capture and safely support a small volar rim fracture (VRF) type of distal radius and obtain sufficient initial fixation. The difficulty in treating VRF has led to various management options and may result in axial instability if the fixation is inadequate. Additionally, flexor tendon rupture is common if the plate is placed too close to the volar rim. This study investigates the impact of using osteochondral capsular suture in conjunction with volar locking plate fixation for dorsally dislocated VRF of the distal radius.  

This case report examines two cases of dorsally dislocated VRF of the distal end of the radius treated with open reduction and internal fixation using volar locking plates and osteochondrocapsular sutures. The authors have developed a method to address these limitations by using a volar locking plate positioned proximally to match Soong's classification grade 0. This is combined with the reinforcement of suturing the distal bone fragment, including bone, cartilage, and joint capsule (Osteochondrocapsular suture), which is then tied to the plate. 

At the 3-month follow-up evaluation, the patient was pain-free with full range of motion in flexion, extension of the wrist, and pronosupination of the forearm. Radiographic analysis indicated that the combined use of volar locking plates and osteochondrocapsular sutures effectively maintained anatomical alignment of all parameters, including radial inclination, radial height, volar tilt, ulnar variance, coronal shift, anteroposterior distance, and tear drop angle. Additionally, the incidence of symptomatic flexor tenosynovitis was monitored, showing no cases of flexor tendon injuries.

The osteochondrocapsular suture technique, when used alongside a volar locking plate, offers a viable solution for maintaining anatomical reduction, bony alignment, and reducing complications such as flexor tendon injuries, without the need for later removal of the plate in dorsally dislocated volar rim fractures of the distal radius. However, it cannot be used for fractures with volar displacement of the volar rim fragment because it cannot buttress the volar rim fragment. Comparative studies are required to assess the effectiveness of this technique in comparison with other options.

Keywords: Volar rim fracture, Osteochondrocapsular suture, Distal radius fracture, Volar locking plate