Editor's Choice| Volume 45, ISSUE 6, P495-502, June 2020

Characterization of the Dorsal Ulnar Corner in Distal Radius Fractures in Postmenopausal Females: Implications for Surgical Decision Making

Published:April 05, 2020DOI:


      To characterize the dorsal ulnar corner fragment with regard to size and morphology using 3-dimensional software and computed tomography (CT) scans, as it presents in low-energy intra-articular distal radius fractures occurring in the female postmenopausal population.


      A multicenter retrospective review was conducted to identify postmenopausal females with low-energy distal radius fractures treated surgically at level-1 trauma centers. Patients with low-energy injuries with preoperative CT scans were included. The Digital Imaging and Communications in Medicine (DICOM) data from CT scans were used to reconstruct intra-articular fracture patterns. The dorsal ulnar fragment was isolated in each CT scan and measured, then normalized based on lunate depth.


      Eighty patients met the inclusion criteria. The mean dimension measurements of the dorsal ulnar corner were dorsal surface height, 9.82 ± 5.02 mm (95% confidence interval [95% CI], 8.72–10.92); dorsal surface width, 9.06 ± 3.72 mm (95% CI, 8.25–9.88); articular surface width, 7.44 ± 3.92 mm (95% CI, 6.58–8.30); articular surface depth, 4.14 ± 2.39 mm (95% CI, 3.62–4.67). The mean lunate depth measurement (17.52 ± 1.48 mm) was used to normalize articular surface depth demonstrating that, on average, the dorsal ulnar corner comprises 23.6% of the articular surface ± 13.6% (95% CI, 20.7–26.6).


      The mean articular surface depth of the dorsal ulnar corner fragment in this study was less than 5 mm, accounting for approximately 24% of the volar-dorsal width of the distal radius at the lunate facet.

      Clinical relevance

      These data expand current understanding of the morphology and size of the dorsal ulnar corner fracture fragment. If fixation of this fragment is a goal, surgeons may need to use longer screws that penetrate closer to the dorsal cortex than those required for extra-articular fractures or to consider alternative methods of fragment-specific fixation for adequate capture of this fragment.

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        • Chung K.C.
        • Spilson S.V.
        The frequency and epidemiology of hand and forearm fractures in the United States.
        J Hand Surg Am. 2001; 26: 908-915
        • Medoff R.J.
        Essential radiographic evaluation for distal radius fractures.
        Hand Clin. 2005; 21: 279-288
        • Melone Jr., C.P.
        Distal radius fractures: patterns of articular fragmentation.
        Orthop Clin North Am. 1993; 24: 239-253
        • Brogan D.M.
        • Richard M.J.
        • Ruch D.
        • Kakar S.
        Management of severely comminuted distal radius fractures.
        J Hand Surg Am. 2015; 40: 1905-1914
        • Mauck B.M.
        • Swigler C.W.
        Evidence-based review of distal radius fractures.
        Orthop Clin North Am. 2018; 49: 211-222
        • Rhee P.C.
        • Medoff R.J.
        • Shin A.Y.
        Complex distal radius fractures: an anatomic algorithm for surgical management.
        J Am Acad Orthop Surg. 2017; 25: 77-88
        • Dy C.J.
        • Wolfe S.W.
        • Jupiter J.B.
        • Blazar P.E.
        • Ruch D.S.
        • Hanel D.P.
        Distal radius fractures: strategic alternatives to volar plate fixation.
        Instr Course Lect. 2014; 63: 27-37
        • Berglund L.M.
        • Messer T.M.
        Complications of volar plate fixation for managing distal radius fractures.
        J Am Acad Orthop Surg. 2009; 17: 369-377
        • Lafontaine M.
        • Hardy D.
        • Delince P.
        Stability assessment of distal radius fractures.
        Injury. 1989; 20: 208-210
        • Court-Brown C.M.
        • Caesar B.
        Epidemiology of adult fractures: a review.
        Injury. 2006; 37: 691-697
        • Ljungquist K.L.
        • Agnew S.P.
        • Huang J.I.
        Predicting a safe screw length for volar plate fixation of distal radius fractures: lunate depth as a marker for distal radius depth.
        J Hand Surg Am. 2015; 40: 940-944
        • Chung K.C.
        • Shauver M.J.
        • Birkmeyer J.D.
        Trends in the United States in the treatment of distal radial fractures in the elderly.
        J Bone Joint Surg Am. 2009; 91: 1868-1873
        • Harness N.G.
        • Jupiter J.B.
        • Orbay J.L.
        • Raskin K.B.
        • Fernandez D.L.
        Loss of fixation of the volar lunate facet fragment in fractures of the distal part of the radius.
        J Bone Joint Surg Am. 2004; 86: 1900-1908
        • Carter P.R.
        • Frederick H.A.
        • Laseter G.F.
        Open reduction and internal fixation of unstable distal radius fractures with a low-profile plate: a multicenter study of 73 fractures.
        J Hand Surg Am. 1998; 23: 300-307
        • Al-Rashid M.
        • Theivendran K.
        • Craigen M.
        Delayed ruptures of the extensor tendon secondary to the use of volar locking compression plates for distal radial fractures.
        J Bone Joint Surg Br. 2006; 88: 1610-1612
        • Cole D.W.
        • Elsaidi G.A.
        • Kuzma K.R.
        • Kuzma G.R.
        • Smith B.P.
        • Ruch D.S.
        Distal radioulnar joint instability in distal radius fractures: the role of sigmoid notch and triangular fibrocartilage complex revisited.
        Injury. 2006; 37: 252-258
        • Wall L.B.
        • Brodt M.D.
        • Silva M.J.
        • Boyer M.I.
        • Calfee R.P.
        The effects of screw length on stability of simulated osteoporotic distal radius fractures fixed with volar locking plates.
        J Hand Surg Am. 2012; 37: 446-453
        • Lee J.I.
        • Cho J.H.
        • Lee S.J.
        The effects of the Frag-Loc compression screw on distal radius fracture with a displaced dorsoulnar fragment.
        Arch Orthop Trauma Surg. 2015; 135: 1315-1321
        • Kim J.K.
        • Yun Y.-H.
        • Kim D.J.
        The effect of displaced dorsal rim fragment in a distal radius fracture.
        J Wrist Surg. 2016; 5: 31-35
        • Lutz M.
        • Arora R.
        • Krappinger D.
        • Wambacher M.
        • Rieger M.
        • Pechlaner S.
        Arthritis predicting factors in distal intraarticular radius fractures.
        Arch Orthop Trauma Surg. 2011; 131: 1121-1126
        • Rozental T.D.
        • Bozentka D.J.
        • Katz M.A.
        • Steinberg D.R.
        • Beredjiklian P.K.
        Evaluation of the sigmoid notch with computed tomography following intra-articular distal radius fracture.
        J Hand Surg Am. 2001; 26: 244-251
        • Rozental T.D.
        • Blazar P.E.
        Functional outcome and complications after volar plating for dorsally displaced, unstable fractures of the distal radius.
        J Hand Surg Am. 2006; 31: 359-365
        • Erhart S.
        • Toth S.
        • Kaiser P.
        • Kastenberger T.
        • Deml C.
        • Arora R.
        Comparison of volarly and dorsally displaced distal radius fracture treated by volar locking plate fixation.
        Arch Orthop Trauma Surg. 2018; 138: 879-885
        • Hozack B.A.
        • Tosti R.J.
        Fragment-specific fixation in distal radius fractures.
        Curr Rev Musculoskelet Med. 2019; 12: 190-197
        • Geissler W.B.
        • Clark S.M.
        Fragment-specific fixation for fractures of the distal radius.
        J Wrist Surg. 2016; 5: 22-30
        • Spiteri M.
        • Ng W.
        • Matthews J.
        • Power D.
        • Brewster M.
        Three year review of dorsal plating for complex intra-articular fractures of the distal radius.
        J Hand Surg Asian Pac Vol. 2018; 23: 221-226
        • Ikeda K.
        • Osamura N.
        • Tada K.
        Fixation of an ulnodorsal fragment when treating an intra-articular fracture in the distal radius.
        Hand Surg. 2014; 19: 139-144
        • Ozer K.
        • Wolf J.M.
        • Watkins B.
        • Hak D.J.
        Comparison of 4 fluoroscopic views for dorsal cortex screw penetration after volar plating of the distal radius.
        J Hand Surg Am. 2012; 37: 963-967