Purpose
Distal radius (DR) fracture fixation with volar locked plating typically uses indirect
fracture reduction without direct visualization of the articular surface in an attempt
to preserve the volar radiocarpal ligaments and prevent iatrogenic radiocarpal instability.
This study assessed the biomechanical stability after a volar radiocarpal arthrotomy
for direct articular visualization for DR fracture repair compared to a standard trans-flexor
carpi radialis approach without arthrotomy in a cadaver model.
Methods
Ten fresh-frozen upper extremity matched-pair cadaveric specimens were tested. For
each pair, one limb underwent trans-FCR approach with a volar arthrotomy that partially
sectioned the long and short radiolunate ligaments to visualize the DR articular surface
(Group 1). The contralateral limb underwent standard trans-FCR approach without arthrotomy
(Group 2). Following capsular repair (Group 1), all specimens (Groups 1 and 2) underwent
biomechanical testing, including axial loading (22.2 N, 44.5 N, 89.0 N, 177.9 N),
volar translational, and dorsal translation loading (22.2 N, 44.5 N, 89.0 N) to assess
carpal stability using both fluoroscopy and motion capture. Ulnar carpal translation
was assessed using the Gilula method, measuring radiographic lunate overhang from
the ulnar edge of the lunate fossa relative to the full width of the lunate. Dorsal
and volar translation were assessed by measuring lunate overhang with respect to the
dorsal or volar radial cortex. To simulate fractures with dorsal radiocarpal ligament
disruption, the dorsal capsule was sectioned, and the biomechanical comparisons were
repeated.
Results
Ulnar translation of the lunate remained below 2 mm for both groups in all testing
scenarios. No significant differences were identified in ulnar, volar, or dorsal translation
with increasing loads between the groups.
Conclusions
This volar ligament-sparing radiocarpal arthrotomy did not cause biomechanical radiocarpal
instability.
Clinical relevance
This arthrotomy may provide enhanced visualization of the DR articular surface during
fracture fixation without causing iatrogenic wrist instability.
Key words
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Article info
Publication history
Published online: October 28, 2022
Accepted:
August 23,
2022
Received:
January 27,
2022
Publication stage
In Press Corrected ProofFootnotes
Dr Douleh was awarded an American Foundation for Surgery of the Hand Resident Research Fast Track Grant for this project. No benefits in any form have been received or will be received by the other authors related directly or indirectly to the subject of this article.
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© 2022 by the American Society for Surgery of the Hand. All rights reserved.
