Assessment and Management of Acute Volar Rim Fractures

Abstract

The volar rim of the distal radius is the only bony restraint to volar carpal subluxation. Higher loads across the volar rim require stable and rigid fixation to maintain reduction and allow healing while rehabilitation begins. Volar marginal fragments are not amenable to buttressing by fixed angle volar locking plates. Appropriate management of volar marginal fragments comprises two steps—recognition of their presence and rigid anatomical repair. The best opportunity for success in the presence of a volar marginal fragment is its adequate initial treatment. The purpose of this review is to reinforce the importance of a complete preoperative and intraoperative evaluation of distal radius fractures. Volar marginal fragments can easily be overlooked even following initial reduction and fixation. Understanding the relevant anatomy and loading parameters can facilitate intraoperative decisions on approach and fixation, which are integral to achieving optimal clinical outcomes.

A Volar Locking Plate With Fossa Specific Fixation Provides Comparable Stability Between Articular and Nonarticular Cadaveric Models of Distal Radius Fracture

“…In the case of articular fragment vascular disruption which can occur with a volar marginal fragment, greater stiffness may be needed for healing to occur. 10,[37][38][39] Limitations of the current work include those that are inherent to biomechanical testing. Cadavers have variable bone density, and the biological tissue is not consistent across specimens.…”

Volar Rim Fractures of the Distal Radius: Can We Reduce the Complications and Need for Revision Surgery?

“…2 Heifner and Orbay provided a review of the principles of the watershed line and the management of volar rim distal radius fractures. 3 This paper highlighted the value of the extended flexor carpi radialis approach, to exposure and reduce the fractures (►Fig. 3).…”

“…1). [1][2][3][4][5][6][7][8] Clarnette et al provided a paper on the mapping of the volar rim fractures and how they relate to the osteoligamentous units (►Fig. 2).…”

“…The volar marginal fragment has been stabilized with a volar locking plate and hook plate extension which captures the fragment. 3 load and stabilizing the radiocarpal and distal radioulnar joints. 4 This paper introduced the concept of the calcar of the distal radius, which extends from the volar ulnar metaphysis to the subchondral bone plate of the distal radius.…”

“…4 Osteoligamentous concept of distal radius fractures-(A) Volar ulnar corner fragment, SRLL, and lunate. 3 (B) "Sleeper Lesion" avulsion of the LRLL is often missed due to subtle radiological changes but can result in delayed carpal instability if not identified and addressed. (Image courtesy: Max Crespi and Greg Bain.)…”