Purpose
Loss of full wrist range of motion is common after treatment of distal radius fractures.
Loss of wrist extension limiting functional activities, although uncommon, can occur
after volar plating of distal radius fractures. Unlike other joints in which capsular
release is a common form of treatment for stiffness, this has been approached with
caution in the wrist owing to concerns for carpal instability. We tested the null
hypothesis that hardware removal and open volar capsular release would not lead to
improved upper extremity-specific patient-reported outcome (Disabilities of the Arm,
Shoulder, and Hand [DASH] questionnaire).
Methods
We conducted a retrospective chart review of patients who underwent a tenolysis of
the flexor carpi radialis tendon, removal of hardware, and subperiosteal release of
the volar capsule (extrinsic ligaments). The primary outcome measure was patient-reported
outcome on the DASH. Secondary outcomes included wrist flexion, extension, pronation,
and supination, visual analog scale for pain, and radiographs/fluoroscopy for ulnocarpal
translocation.
Results
Eleven patients were treated with a mean follow-up of 4.5 years. Mean DASH scores
improved after surgery. Mean wrist flexion, wrist extension, pronation, and supination
improved after surgery. Mean visual analog scale scores did not change. The radiocarpal
relationship on radiographs/fluoroscopy was normal.
Conclusions
Open volar capsular release to regain wrist extension after treatment of distal radius
fractures with volar locking plates is safe and effective. Patients regain wrist extension
in addition to improved DASH scores. There were no radiographic/fluoroscopic or clinical
signs of ulnocarpal translocation after release of the volar extrinsic ligaments.
Type of study/level of evidence
Therapeutic IV.
Key words
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Article info
Publication history
Published online: September 14, 2017
Accepted:
August 1,
2017
Received:
March 21,
2016
Footnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
Copyright
© 2017 by the American Society for Surgery of the Hand. All rights reserved.
