Arch Hand Microsurg.  2018 Sep;23(3):150-157. 10.12790/ahm.2018.23.3.150.

Limited Dorsal Approach for Intra-Articular Distal Radius Fracture Involving the Sigmoid Notch

• Oh BS
• Choi YR
• Ko IH
• Oh WT
• Kim NH
• Kang HJ

• KMID: 2419449
• DOI: http://doi.org/10.12790/ahm.2018.23.3.150

Abstract

PURPOSE
The purpose of this study was to analyze the 16 patients, with distal radius fracture involving sigmoid notch fracture, who were treated by limited dorsal approach retrospectively.
METHODS
Between June 2003 and December 2013, 743 patients with distal radius fracture underwent operative treatment. Among them, 16 patients received conventional treatment, with additional limited dorsal approach. The fracture patterns involved sigmoid notch with dorsal lunate fossa depression, as well as distally displaced dorsal rim fragment. Radiologic results were evaluated based on dorsal tilt, radial inclination, and radial shortening. Clinical results were evaluated based on grip strength, motion range of the wrist joint, arm disabilities, shoulder & hand (DASH) score, and visual analogue scale (VAS) score.
RESULTS
The average radial inclination was 21°, with 5.6° of volar tilt and 0.1 mm of radial shortening. The average range of motion were 42.6° of flexion, 56.5° of extension, 23.4° of radial tilt, and 24.8° of ulnar tilt. The average grip strength was 81.3% of the opposite side. The average VAS and DASH scores were 1.1 and 21.3, respectively.
CONCLUSION
In the case of sigmoid notch fracture involving dorsal lunate fossa depression fractures and distally displaced dorsal rim fractures, we were able to reduce and fix the fragment conveniently using limited dorsal approach.

Keyword

Distal radio-ulnar joint; Distal radius fracture; Limited dorsal approach; Lunate fossa depression fracture; Dorsal rim fracture

MeSH Terms

Arm
Colon, Sigmoid*
Depression
Hand
Hand Strength
Humans
Radius Fractures*
Radius*
Range of Motion, Articular
Retrospective Studies
Shoulder
Wrist Joint

Figure

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  Fig. 1 Fifty six years female patient with distal radius fracture, fall on outstretched hand. Initial radiograph shows comminuted intra-articular distal radius fracture and dorsal fragment distal migration.

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  Fig. 2 Computed tomography shows dorsal fragment distal migration and sigmoid notch involvement.

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  Fig. 3 After volar plate and screw fixation, additional limited dorsal approach was done. After making 2 cm longitudinal incision, operation field is retracted with Senn retractor and silicon tube. Then, reduction is done using dura elevator.

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  Fig. 4 Final radiograph shows satisfactory result without sclerotic change in distal radioulnar joint and radio-carpal joint.

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  Fig. 5 The efficacy of limited dorsal approach, the limited dorsal approach makes it convenient to recover articular surface both distal radio-ulnar joint and radiocarpal joint.

Reference

1. Liporace FA, Adams MR, Capo JT, Koval KJ. Distal radius fractures. J Orthop Trauma. 2009; 23:739–748.

2. Liporace FA, Gupta S, Jeong GK, et al. A Biomechanical comparison of a dorsal 3.5mm T-plate and a volar fixed-angle plate in a model of dorsally ustable distal radius fractures. J Orthop Trauma. 2005; 19:187–191.

3. Nakanishi Y, Omokawa S, Shimizu T, Nakano K, Kira T, Tanaka Y. Intra-articular distal radius fractures involving the distal radioulnar joint (DRUJ): three dimensional computed tomography-based classification. J Orthop Sci. 2013; 18:788–792.

4. Knirk JL, Jupiter JB. Intra-articular fractures of the distal end of the radius in young adults. J Bone Joint Surg Am. 1986; 68:647–659.

5. Bradway JK, Amadio PC, Cooney WP. Open reduction and internal fixation of displaced, comminuted intra-articular fractures of the distal end of the radius. J Bone Joint Surg Am. 1989; 71:839–847.

6. Fernandez DL. Radial osteotomy and Bowers arthroplasty for malunited fractures of the distal end of the radius. J Bone Joint Surg Am. 1988; 70:1538–1551.

7. Jenkins NH, Mintowt-CZYZ WJ. Mal-union and dysfunction in Colles’ fracture. J Hand Surg Br. 1988; 13:291–293.

8. McQueen M, Caspers J. Colles fracture: does the anatomical result affect the final function? J Bone Joint Surg Br. 1988; 70:649–651.

9. Crisco JJ, Moore DC, Marai GE, et al. Effects of distal radius malunion on distal radioulnar joint mechanics--an in vivo study. J Orthop Res. 2007; 25:547–555.

10. Adams BD. Effects of radial deformity on distal radioulnar joint mechanics. J Hand Surg Am. 1993; 18:492–498.

11. Kihara H, Palmer AK, Werner FW, Short WH, Fortino MD. The effect of dorsally angulated distal radius fractures on distal radioulnar joint congruency and forearm rotation. J Hand Surg Am. 1996; 21:40–47.

12. Vitale MA, Brogan DM, Shin AY, Berger RA. Intra-articular fractures of the sigmoid notch of the distal radius: analysis of progression to distal radial ulnar joint arthritis and impact on upper extremity function in surgically treated fractures. J Wrist Surg. 2016; 5:52–58.

13. Na KT, Song SW, Lee YM, Kang BM. Dorsal plate fixation for dorsally displaced distal radius fractures. J Korean Soc Surg Hand. 2014; 19:44–51.

14. Simic PM, Robison J, Gardner MJ, Gelberman RH, Weiland AJ, Boyer MI. Treatment of distal radius fractures with a low-profile dorsal plating system: an outcomes assessment. J Hand Surg Am. 2006; 31:382–386.

15. Rein S, Schikore H, Schneiders W, Amlang M, Zwipp H. Results of dorsal or volar plate fixation of AO type C3 distal radius fractures: a retrospective study. J Hand Surg Am. 2007; 32:954–961.

16. Wichlas F, Haas NP, Disch A, Macho D, Tsitsilonis S. Complication rates and reduction potential of palmar versus dorsal locking plate osteosynthesis for the treatment of distal radius fractures. J Orthop Traumatol. 2014; 15:259–264.

17. Axelrod T, Paley D, Green J, McMurtry RY. Limited open reduction of the lunate facet in comminuted intraarticular fractures of the distal radius. J Hand Surg Am. 1988; 13:372–377.

18. Leung KS, Shen WY, Tsang HK, Chiu KH, Leung PC, Hung LK. An effective treatment of comminuted fractures of the distal radius. J Hand Surg Am. 1990; 15:11–17.

19. Ikeda K, Osamura N, Tada K. Fixation of an ulnodorsal fragment when treating an intra-articular fracture in the distal radius. Hand Surgery. 2014; 19:139–144.

20. Kim JK, Yun YH, Kim DJ. The effect of displaced dorsal rim fragment in a distal radius fracture. J Wrist Surg. 2016; 5:31–35.