Scientific Article|Articles in Press

Ligament-Sparing Volar Radiocarpal Arthrotomy During Distal Radius Fracture Repair: Anatomical Description and Quantification of Articular Surface Area Visualized in a Cadaveric Model

Published:October 14, 2022DOI:


      Distal radius (DR) fracture repair using the volar locked plating technique typically involves indirect fracture reduction, assessed using fluoroscopy, without direct visualization of the articular surface. This method of fracture repair may be guided by the rationale that volar radiocarpal ligament disruption may cause radiocarpal instability, although direct articular visualization may facilitate improved fracture reduction. This study investigated anatomical feasibility and articular surface visualization using volar ligament-sparing radiocarpal arthrotomy pertinent to DR fracture repair.


      Ten fresh-frozen cadaveric specimens of the upper extremity underwent volar arthrotomy via the standard flexor carpi radialis approach with partial longitudinal sectioning of the long radiolunate and partial transverse sectioning of the short radiolunate ligaments to visualize the articular surface of the DR. Following arthrotomy, the visible surface of the DR was analyzed using digital photography. The wrist was disarticulated, and the fully exposed articular surface was photographed. The visible area of the articular surface was quantified using digital imaging software by calculating the ratio of the surface area visualized using the arthrotomy to the total articular surface area.


      The percentage of the articular surface area of the DR visualized using the volar arthrotomy was 76% ± 7.6% (range, 69%–90%), including both the scaphoid facet, lunate facet, and scapholunate ridge.


      Volar radiocarpal arthrotomy allows clinically relevant visualization of the articular surface of the DR, including the scaphoid and lunate facets.

      Clinical relevance

      Radiocarpal arthrotomy may facilitate improved articular reduction during DR fracture repair via the volar approach.

      Key words

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        • Nellans K.W.
        • Kowalski E.
        • Chung K.C.
        The epidemiology of distal radius fractures.
        Hand Clin. 2012; 28: 113-125
        • MacIntyre N.J.
        • Dewan N.
        Epidemiology of distal radius fractures and factors predicting risk and prognosis.
        J Hand Ther. 2016; 29: 136-145
        • Kreder H.J.
        • Hanel D.P.
        • Agel J.
        • et al.
        Indirect reduction and percutaneous fixation versus open reduction and internal fixation for displaced intra-articular fractures of the distal radius: a randomised, controlled trial.
        J Bone Joint Surg Br Vol. 2005; 87: 829-836
        • Nasab M.H.
        • Azar M.S.
        • Fazel Moghaddam S.F.
        • Taghipour M.
        Success rate and complications of comminuted intra-articular distal radius fracture treatment via closed reduction and use of a mini-external fixator.
        Trauma Mon. 2015; 20 (e18885–e18885)
        • Knirk J.L.
        • Jupiter J.B.
        Intra-articular fractures of the distal end of the radius in young adults.
        J Bone Joint Surg Am Vol. 1986; 68: 647-659
        • Trumble T.E.
        • Schmitt S.R.
        • Vedder N.B.
        Factors affecting functional outcome of displaced intra-articular distal radius fractures.
        J Hand Surg. 1994; 19: 325-340
        • Goldfarb C.A.
        • Rudzki J.R.
        • Catalano L.W.
        • Hughes M.
        • Borrelli Jr, J.
        Fifteen-year outcome of displaced intra-articular fractures of the distal radius.
        J Hand Surg Am. 2006; 31: 633-639
        • III Catalano, L.W.
        • Cole R.J.
        • Gelberman R.H.
        • Evanoff B.A.
        • Gilula L.A.
        • Borrelli Jr., J.
        Displaced intra-articular fractures of the distal aspect of the radius. Long-term results in young adults after open reduction and internal fixation.
        J Bone Joint Surg Am. 1997; 79: 1290-1302
        • Varitimidis S.E.
        • Basdekis G.K.
        • Dailiana Z.H.
        • Hantes M.E.
        • Bargiotas K.
        • Malizos K.
        Treatment of intra-articular fractures of the distal radius: fluoroscopic or arthroscopic reduction?.
        J Bone Joint Surg Br Vol. 2008; 90: 778-785
        • Fernandez J.J.
        • Gruen G.S.
        • Herndon J.H.
        Outcome of distal radius fractures using the short form 36 health survey.
        Clin Orthop Relat Res. 1997; : 36-41
        • Lutsky K.
        • Boyer M.I.
        • Steffen J.A.
        • Goldfarb C.A.
        Arthroscopic assessment of intra-articular distal radius fractures after open reduction and internal fixation from a volar approach.
        J Hand Surg. 2008; 33: 476-484
        • Disseldorp D.J.
        • Hannemann P.F.
        • Poeze M.
        • Brink P.R.
        Dorsal or volar plate fixation of the distal radius: does the complication rate help us to choose?.
        J Wrist Surg. 2016; 5: 202-210
        • Abe Y.
        • Tokunaga S.
        • Moriya T.
        Management of intra-articular distal radius fractures: volar or dorsal locking plate—which has fewer complications?.
        Hand (N Y). 2017; 12: 561-567
        • Vasenius J.
        Operative treatment of distal radius fractures.
        Scand J Surg. 2008; 97: 290-296
        • Edwards II, C.C.
        • Haraszti C.J.
        • McGillivary G.R.
        • Gutow A.P.
        Intra-articular distal radius fractures: arthroscopic assessment of radiographically assisted reduction.
        J Hand Surg Am. 2001; 26: 1036-1041
        • Augé II, W.K.
        • Velázquez P.A.
        The application of indirect reduction techniques in the distal radius: the role of adjuvant arthroscopy.
        Arthroscopy. 2000; 16: 830-835
        • Haus B.M.
        • Jupiter J.B.
        Intra-articular fractures of the distal end of the radius in young adults: reexamined as evidence-based and outcomes medicine.
        J Bone Joint Surg Am Vol. 2009; 91: 2984-2991
        • Johnson N.
        • Leighton P.
        • Pailthorpe C.
        • Dias J.
        • Distal Radius Fracture Delphi Study Group
        Defining displacement thresholds for surgical intervention for distal radius fractures—a Delphi study.
        PLoS One. 2019; 14e0210462