Intra-articular distal radius fracture. Not a shoulder and not an elbow problem but....

In a shoulder and elbow blog the post of a distal radius fracture is without a doubt not relevant. The following case is a female in her 40s who presented in the office complaining of pain to the wrist after a fall on an outstretched hand while playing volleyball. I have always been amazed by the incredible design of the plates that have been introduced in the treatment of distal radius fractures and I have to admit that it is one of the injuries that is interesting in treating and studying due to the "many personalities" of this fracture. In addition, I prefer to offer operative treatment for these fractures in the young and active patients always in accordance with the criteria that have been developed by the AAOS (please see following link). I would strongly encourage surgeons who encounter patients with fractures of the distal radius to refer them in a timely fashion to experienced surgeons for assessment and treatment. The reason lies that based on this study (click here) it is the number one reason for malpractice lawsuits. Watching a fracture collapse with serial XRs is the most common mistake made in the treatment of these fractures. (J Bone Joint Surg Am. 2013 Feb 20;95(4):e201-8. Lessons regarding the safety of orthopaedic patient care: an analysis of four hundred and sixty-four closed malpractice claims.
Matsen FA 3rd1, Stephens L, Jette JL, Warme WJ, Posner KL).

To go back to the case that was seen in our office, the following radiographs demonstrate an intra-articular distal radius fracture with a lunate facet fragment which is displaced and intra-articular gapping. Based on this study (Corrective osteotomy for isolated malunion of the palmar lunate facet in distal radius fractures. Ruch DS, Wray WH 3rd, Papadonikolakis A, Richard MJ, Leversedge FJ, Goldner RD. J Hand Surg Am. 2010 Nov;35(11):1779-86.) a displaced lunate facet leads to significant loss of forearm supination and disability and for this reason needs to be addressed surgically. In addition, the intra-articular gapping necessitates restoration of the smoothness of the articular surface. 

We elected to use a volar locking plate for this fracture, restore the smoothness of the articular surface and reduce the displaced lunate facet fragment.

Lateral view

10 degree tilted lateral view

immediate postop AP Xray

immediate postop oblique Xray

The following drawing is taken from the Textbook Rockwood and Wilkins Fractures in Adults. It indicates that dorsal plates may result in hardware prominence due to the Lister's tubercle on the dorsum of the wrist. On the contrary, volar plates can be manufactured in a way that they follow the contour of the bone, can be low profile and have less chances of prominence. It seems that most surgeons use volar plates for the treatment of these fractures.