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Friday, March 12, 2004

Researchers identify pitfalls in treating distal radius volar shear fractures

By Mary Ann Porucznik

Traditionally, plate fixation is used to treat volar shear fractures (Barton fractures) of the distal radius. Researchers for Poster Exhibit P450 have identified two significant pitfalls that may require a surgeon to make modifications in the standard volar buttress plating to limit problems.

The research was conducted in two parts. During the first part, which spanned an eight-year period, surgeons treated 44 consecutive patients with a volar shearing fracture of the distal radius with standard volar buttress plating.

During this period, surgeons noted two pitfalls. A small volar lunate facet fragment in four patients with comminuted volar articular margin led to subluxation of the carpus. In three other patients, an unrecognized dorsal metaphyseal fracture line led to dorsal translation and angulation of the articular fragments. As a result, surgeons modified their technique to account for a dorsal metaphyseal fracture line, radial styloid fracture, and small volar lunate facet fragments.

During a subsequent three-year period, 33 consecutive patients with a volar shearing fracture of the distal radius were treated with the modified technique. None of these patients had volar subluxation of the carpus or dorsal translation of the articular fragments.

Researchers concluded that while fractures of the volar articular margin of the distal radius are best treated with volar plate and screw fixation, surgeons should be aware of common, but often unrecognized injury components, such as a small volar lunate fragment with carpal subluxation and overreduction of the articular fragments or radial styloid, and modify the plating technique when needed.

Researchers included David Ring, MD, of Boston; Neil G. Harness, MD, of Somerville, Mass., and Jesse B. Jupiter, MD, of Weston, Mass.

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