WIRE- LOOP FIXATION OF THE VOLAR RIM FRAGMENT OF THE DISTAL RADIUS

Abstract

Fracture of the volar rim of the distal radius could be an isolated fracture or part of a complex type of fracture. Frequently it is displaced and rotated because of the attachment of the volar radio-carpal ligaments. Fixation of this fragment is mandatory to preserve integrity of radio-carpal and distal radio-ulnar joints. Given the difficulty of manipulation of this osteochondral fragment we studied the efficiency of a wire-loop as a method of fixation of this fragment.

Eleven patients were examined (8 male, 3 female) mean age 42,6 years (21–72 years) who had various type of fractures of the distal radius but had in common the presence of an osteochondral fracture of the volar radial rim in the ulnar side (7 patients), in the radial side (3 patients) or on both sides (1 patient). Distal radius fracture was type B3.1 (1 patient), B3.3 (4 patients), C3.1 (3 patients), C1.3 (1 patient) and radiocarpal fracture-dislocation in 2 cases. All patients were treated operatively. Eight of them had early (1 – 10 days post-injury) and three had delayed treatment (1 month post-injury). The rim fragment was found displaced in all patients and rotated 45°-180° in 5 patients. Different types of fixation of the distal radius fractures were used, while in all patients the rim fragment was fixed using a wire loop.

Results were estimated after a mean follow-up of 1 year (6 months- 4 years) using clinical (pain, function, range of motion, grip strength) (Cooney 1987) and radiological (articular congruence, arthritis) criteria. Results were evaluated as excellent (4 patients), good (5 patients) fair (1 patient) and poor (1 patient), while in two cases there was loss of fragment reduction.

In conclusion, although intraarticular fractures are often associated with injury of the interosseous ligaments, probably they have no effect on the integrity of the volar radiocarpal ligaments, the origins of which could influence the volar rim fracture displacement. Wire loop is a valid method for fixation of osteochondral fracture of the volar radial rim, giving stability and avoiding comminution and necrosis of the fragment.