Treatment of volar rim fractures of the distal radius with a volar rim plate

Treatment of distal radial fractures with small volar rim fragments can be difficult. Because of the paucity of published outcomes, the aim of this study was to analyze the clinical and radiographic outcomes and complications of volar rim plate (VRP) fixation for volar rim fractures of the distal radius

We retrospectively reviewed 19 patients in whom a VRP with locking screws was used between May 2019 and April 2021. Loss of reduction was defined as change in carpal translation > 4 mm or change in lunate subsidence distance > 3 mm. Patient characteristics, injury mechanisms, radiographic parameters, and follow-up were analyzed using descriptive statistics and presented as median with range and interquartile range (IQR) because the limited number of patients led to a non-normal distribution of data in the study. A scatter plot was drawn to analyze the possible predictors of loss of reduction.

After a median follow-up of 18 months (range 6, 32; IQR 14, 26), median wrist flexion and extension arc was 70 °(range 50°, 80°; IQR 60°, 70°), median grip strength was 80% of the contralateral side (range 52, 104; IQR 77, 88), median visual analogue scale score for pain was 0 (range 0, 5; IQR 0, 1),  median disabilities of the arm, shoulder, and hand score was 2 (range 0, 59; IQR 0, 11), and median modified Mayo wrist score was 80 (range 35, 100; IQR 75, 85). Two patients exhibited loss of reduction; one was treated conservatively, and the other underwent revision surgery. There was no flexor tendon disruption, but three developed transient flexor tenosynovitis. No vascular injury was noted, but three developed carpal tunnel syndrome following surgery.

Our findings support that VRP can be an effective treatment option for volar rim fractures if they are properly placed. However, two failed cases were still noted. Therefore, the patients must be counseled that VRP fixation was not free from loss of reduction. A suboptimal plate coverage (>5mm) following a greater preoperative LSD (>5mm) might be associated with loss of reduction. 

Keywords: Distal radial fracture, locking plate, loss of reduction, lunate facet, volar rim, failure