Operative Treatment of Volar Intra-Articular Fractures of the Distal End of the Radius

• Published in: Journal of bone and joint surgery. American volume 1996-12, Vol.78 (12), p.1817-28
• Main Authors: JUPITER, JESSE B, FERNANDEZ, DIEGO L, TOH, CHOON-LAI, FELLMAN, THOMAS, RING, DAVID
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Biological and medical sciences; Female; Fracture Fixation, Internal; Humans; Male; Medical sciences; Middle Aged; Orthopedic surgery; Osteoarthritis - complications; Postoperative Complications; Radiography; Radius Fractures - complications; Radius Fractures - diagnostic imaging; Radius Fractures - surgery; Retrospective Studies; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Treatment Outcome; Wrist Joint - diagnostic imaging
• ISSN: 0021-9355; 1535-1386
• DOI: 10.2106/00004623-199612000-00004

We retrospectively reviewed the results of operative treatment of forty-nine volar marginal intra-articular fractures of the distal end of the radius. According to the Comprehensive Classification of Fractures, there were two B3.1 fractures (characterized by a small volar fragment, with the sigmoid notch intact), three B3.2 fractures (characterized by a large volar fragment that included the sigmoid notch), and forty-four B3.3 fractures (characterized by comminution of the volar fragment). Although all fractures healed and only nine patients had evidence of osteoarthrosis on follow-up radiographs, there were six early and fourteen late complications, some of which adversely influenced the over-all outcome. After an average of fifty-one months (range, twenty-four to 117 months), there were thirty-one excellent, ten good, and eight fair results according to the system described by Gartland and Werley, and thirty-two excellent, nine good, five fair, and three poor results according to the modified system of Green and OʼBrien. Two factors were found to have a significant association with a fair or poor outcomeevidence of osteoarthrosis on the most recent follow-up radiographs and reversal of the normal volar tilt of the distal end of the radius. The age of the patient, the interval from the injury to the operation, a concomitant injury of the ipsilateral upper extremity, an associated fracture of the ulnar styloid process, the radio-ulnar index, ulnar angulation, the classification of the fracture, comminution of the volar fragment, and articular incongruity were not significantly associated with the outcome.