Dorsal Cortical Breaks in Volar Barton Distal Radius Fractures

Background: Volar Barton fractures involve the volar articular margin of the distal radius with proximal and volar subluxation of the carpus. Although traditionally conceptualized as partial articular, some volar Barton fractures are complete articular injuries due to a dorsal cortical break in the distal radial metaphysis. While dorsal cortical breaks can affect surgical strategy, they may be difficult to identify on plain radiographs and their epidemiology remains poorly characterized. Some authors have hypothesized an association with osteoporosis; however, this hypothesis remains untested. To better characterize volar Barton fractures, we analyzed fracture geometry on pre-operative computed tomography (CT) scans to: (1) determine the frequency of a dorsal cortical break; and (2) test the null hypothesis that a dorsal cortical break is not associated with age or gender. Methods: We retrospectively reviewed adults with a volar Barton distal radius fracture and an available pre-operative CT who underwent surgical fixation. Using multivariable logistic regression, we assessed whether age or gender was an independent predictor of a dorsal cortical break. Results: Forty patients (mean age 52 years, 57% female) were identified. Including the shaft as a fragment, 32 (80%) had 3 or more discrete fracture fragments. Thirty patients (75%) had a dorsal cortical break. Dorsal cortical breaks were not associated with either age or gender ( P > 0.05). Conclusions: Most (75%) patients with volar Barton distal radius fractures had a dorsal cortical break. Dorsal cortical breaks were not statistically associated with age or gender, suggesting these fracture patterns may not be associated with osteoporosis as previously hypothesized.

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Classification and Management of Failed Fixation of the Volar Marginal Fragment in Distal Radius Fractures

Journal of Wrist Surgery ◽

10.1055/s-0041-1735885 ◽

2021 ◽

Author(s):

M. Carolina Orbay ◽

Jorge L. Orbay

Keyword(s):

Distal Radius ◽

Patient Characteristics ◽

Distal Radioulnar Joint ◽

Distal Radius Fractures ◽

Volar Plating ◽

Radius Fractures ◽

Fracture Patterns ◽

Loss Of Reduction ◽

Operative Fixation ◽

Specific Fracture

AbstractGreater understanding of specific fracture patterns following distal radius fractures has arisen with the advent of volar plating. The volar marginal fragment (VMF) is a small peripheral piece of bone which is critical to carpal stability. Failure to achieve good fixation of the VMF can result in volar subluxation of the carpus and distal radioulnar joint instability. Due to its small, distal nature, this fragment can be easily missed and difficult to fix. Loss of reduction of the VMF following operative fixation presents specific challenges and surgical considerations dictated by patient characteristics and timing. Our goal of this review is to present a classification system for these failed VMFs which can help guide surgical treatment as well as expected outcomes.

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Concomitant Carpal Injuries in Distal Radius Fractures: Retrospective Analysis by Plain Radiographs and Computed Tomography

Journal of the Korean Fracture Society ◽

10.12671/jkfs.2015.28.1.1 ◽

2015 ◽

Vol 28 (1) ◽

pp. 1 ◽

Cited By ~ 2

Author(s):

Chul-Hyun Cho ◽

Eun-Seok Son

Keyword(s):

Computed Tomography ◽

Retrospective Analysis ◽

Distal Radius ◽

Distal Radius Fractures ◽

Radius Fractures ◽

Plain Radiographs

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A Comparison of Intra-Observer and Inter-Observer Reliability of Plain Radiographs, Standard Computed Tomography Scans and Mobile Computed Tomography Scans in the Assessment of Distal Radius Fractures: A Cadaveric Study

Journal of Health Science and Medical Research ◽

10.31584/jhsmr.202078 ◽

2019 ◽

pp. 53

Author(s):

Sitthiphong Suwannaphisit ◽

Saowapar Yoykaew ◽

Chitchaya Suwanraksa ◽

Varah Yuenyongviwat ◽

Porames Suwanno ◽

...

Keyword(s):

Computed Tomography ◽

Distal Radius ◽

Distal Radius Fractures ◽

Observer Agreement ◽

Ct Scans ◽

Radius Fractures ◽

Plain Radiographs ◽

Observer Reliability ◽

Computed Tomography Scans ◽

Mobile Ct

Objective: Diagnosis of a distal end radius fracture relies on various imaging studies. However, the relative usefulness of these studies is still a matter of some controversy. The aim of this study was to compare the intra-observer and inter-observer reliability of plain radiographs, standard computed tomography (CT) scans and mobile CT scans in the assessment of distal radius fractures as categorized by the Fernandez classification method. The secondary objective was to compare the dosages of radiation between the different imaging modalities. Material and Methods: Sixteen fresh cadaveric wrist bones were used in this experimental study. The desired fractures were created in the bones to mimic Fernandez types I-V fractures and plain radiographs were taken in 4 views. Standard CT and mobile CT scans were also taken with the fractured bones in the same four positions. Interobserver reliability was assessed using Kappa statistics to determine the diagnostic consistency among the nine observers. Inter-observer agreement was assessed based on the Fernandez classification system diagnoses. Results: Overall, the inter-observer agreement was substantial for the Fernandez classifications (Kappa range 0.636 0.727) in all types of imaging. For intra-observer agreement, the analysis found higher agreement for both standard CT scans and mobile CT scans. The standard CT images imparted a higher average dose of radiation than both the mobile CT scans and the plain radiographs.Conclusion: The mobile CT scan can provide an alternative imaging method for precise diagnosis of distal end radius fractures, with the additional benefits of mobility and lower radiation exposure.

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Radiographic Outcomes and Complications of Delayed Fixation of Distal Radius Fractures

Hand ◽

10.1177/1558944720930301 ◽

2020 ◽

pp. 155894472093030

Author(s):

Stella J. Lee ◽

Derek S. Stenquist ◽

Jamie E. Collins ◽

Ariana N. Mora ◽

Brett A. Teplitz ◽

...

Keyword(s):

Cohort Study ◽

Surgical Treatment ◽

Distal Radius ◽

Distal Radius Fractures ◽

X Rays ◽

Matched Cohort ◽

Radius Fractures ◽

Radiographic Outcomes ◽

Radiographic Parameters ◽

Surgical Fixation

Background: Surgeons are sometimes presented with patients with distal radius fractures who present in a delayed fashion or lose reduction after several weeks of attempted closed management. There are limited studies on delayed surgical treatment of distal radius fractures to assist providers in decision-making. Methods: We conducted a matched cohort study to compare radiographic outcomes and complications for patients with a distal radius fracture treated with delayed (3-5 weeks) or early (0-2 weeks) surgical fixation. Patients ages 18+ who underwent open reduction and internal fixation of distal radius fractures by a volar approach at 2 Level I trauma centers between 2003 and 2015 were eligible. We measured radiographic outcomes and reviewed medical records to determine operative approach and complications. Results: There were 25 cases and 50 controls matched for age (18-87), sex, and AO fracture type. The delayed group had surgery at a mean of 24.8 days from injury and the early group at 5.6 days. There was no statistically significant difference between the delayed and early cohorts in radiographic parameters on injury x-rays, in improvement in radiographic parameters on first postoperative x-rays, or in maintenance of radiographic parameters at union. Conclusion: We did not find significant differences in radiographic outcomes or complication rates between patients with delayed versus early surgical treatment for distal radius fracture. Providers treating patients with late presentation or late displacement have the option of surgical fixation beyond the first few weeks after injury. Level of Evidence: III (Retrospective matched cohort study)

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Volar Marginal Rim Fractures of the Distal Radius Have a Higher Rate of Associated Carpal Injuries—A Comparative Cohort Study

Journal of Wrist Surgery ◽

10.1055/s-0041-1729990 ◽

2021 ◽

Author(s):

Nathan Eardley-Harris ◽

Simon B.M. MacLean ◽

Ruurd Jaarsma ◽

Jock Clarnette ◽

Gregory Ian Bain

Keyword(s):

Distal Radius ◽

Revision Surgery ◽

Distal Radius Fractures ◽

Carpal Instability ◽

Radius Fractures ◽

Level Of Evidence ◽

Fixation Failure ◽

Scapholunate Instability ◽

Surgical Fixation ◽

Comparative Cohort Study

Abstract Background Volar marginal rim distal radius fractures can be challenging due to volar instability of the carpus. The associated carpal injuries, however, have not previously been reported. Purpose The aim of this study was to compare volar marginal rim fractures to other distal radius fractures to determine if there is any association with other carpal injuries. If so, do these injuries lead to further instability and fixation failure? Materials and Methods A retrospective radiological review of 25 volar marginal rim fractures was conducted. This was compared with a comparison cohort of 25 consecutive intra-articular distal radius fractures not involving the volar marginal rim. All radiographs were reviewed for associated carpal injuries, including carpal and ulnar styloid fractures, scapholunate instability, and carpal translocation. Results Volar marginal rim fractures had a significantly higher incidence of associated carpal injuries per patient (2.52 vs. 1.64), scapholunate diastasis (36 vs. 12%), and carpal dislocation (80 vs. 48%). The fixation chosen was more likely to involve a volar rim-specific plate (44 vs. 0%). Following surgical fixation, the volar marginal rim fractures had a significantly higher incidence of carpal instability (56 vs. 24%), failure of fixation (24 vs. 0%), and revision surgery (12 vs. 0%). Conclusions Volar marginal rim fractures have significantly more carpal injuries, scapholunate instability, and volar carpal instability, compared with other distal radius fractures. Despite the use of volar rim-specific plating, volar marginal rim fractures have a significantly higher incidence of persistent carpal instability, including scapholunate instability, ulnar translocation, volar subluxation, failure of fixation, and revision surgery. Level of Evidence This is a level III, retrospective review.

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