Volar marginal fragment escape in distal radius fractures. Results of salvage with a volar open wedge articular reorientation osteotomy.

PURPOSE: To investigate the clinical and radiographic outcomes following volar open wedge osteotomy (VOWO) in patients with volar carpal instability resulting from volar marginal fragment (VMF) escape after distal radius fixation.

METHODS

This retrospective cohort study reviewed records of 21 consecutive adult patients treated with VOWO at two urban tertiary care centers in India. All patients had volar carpal translation following failed fixation of a VMF and a minimum follow-up of 1 year. Adjunctive procedures included short radiolunate ligament repair, refixation of large VMFs, and dorsal wrist-spanning fixation when indicated. The primary outcome was osteotomy healing with restoration of radiocarpal stability. Secondary outcomes included wrist range of motion, Mayo wrist score, and complications.

RESULTS

Osteotomy healing with restoration of radiocarpal stability was achieved in all patients. At a mean follow-up of 23 months (range, 14-48 months), significant improvements were observed in wrist motion and function. The mean wrist flexion-extension arc improved from 46° preoperatively (range, 25-70°) to 110°° postoperatively (range, 80-140°, P < 0.001), while the mean pronation-supination arc improved from 90° to 124° (P = 0.023). The mean Mayo wrist score improved from 23 preoperatively (range, 5-50) to 83 at final follow-up (range, 75-100, P < 0.001). Radiographic arthritis involving the radiocarpal joint and distal radioulnar joint (DRUJ) was observed in 2 patients, and DRUJ instability was noted in 2 patients.

CONCLUSIONS

Volar open wedge osteotomy should be considered a salvage procedure, which reliably restores radiocarpal stability while preserving functional wrist and forearm motion in the short term, with minimal complications, in patients with volar carpal instability secondary to VMF escape following distal radius fixation.

LEVEL OF EVIDENCE: IV, Therapeutic study.