Limited Dorsal Approach for Intra-Articular Distal Radius Fracture Involving the Sigmoid Notch

Bum-Suk Oh; Yun-Rak Choi; Il-Hyun Ko; Won-Taek Oh; Nam-Hoo Kim; Ho-Jung Kang

doi:10.12790/ahm.2018.23.3.150

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Oh, Choi, Ko, Oh, Kim, and Kang: Limited Dorsal Approach for Intra-Articular Distal Radius Fracture Involving the Sigmoid Notch

Hand

Archives of Hand and Microsurgery 2018; 23(3): 150-157.

Published online: 31 August 2018

DOI: https://doi.org/10.12790/ahm.2018.23.3.150

Limited Dorsal Approach for Intra-Articular Distal Radius Fracture Involving the Sigmoid Notch

Bum-Suk Oh¹, Yun-Rak Choi², Il-Hyun Ko², Won-Taek Oh², Nam-Hoo Kim², Ho-Jung Kang²

¹Department of Orthopedic Surgery, Duson Hospital, Ansan, Korea.

²Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Korea.

Corresponding author: Ho-Jung Kang. Department of Orthopedic Surgery, Gangnam Severance Hospital, 211 Eonju-ro, Gangnam-gu, Seoul 06273, Korea. TEL: +82-2-2019-3412, FAX: +82-2-573-5393, kangho56@yuhs.ac

Received 24 July 2018 Revised 15 August 2018 Accepted 16 August 2018

Korean Society for Surgery of the Hand, Korean Society for Microsurgery, and Korean Society for Surgery of the Peripheral Nerve

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The purpose of this study was to analyze the 16 patients, with distal radius fracture involving sigmoid notch fracture, who were treated by limited dorsal approach retrospectively.

Methods

Between June 2003 and December 2013, 743 patients with distal radius fracture underwent operative treatment. Among them, 16 patients received conventional treatment, with additional limited dorsal approach. The fracture patterns involved sigmoid notch with dorsal lunate fossa depression, as well as distally displaced dorsal rim fragment. Radiologic results were evaluated based on dorsal tilt, radial inclination, and radial shortening. Clinical results were evaluated based on grip strength, motion range of the wrist joint, arm disabilities, shoulder & hand (DASH) score, and visual analogue scale (VAS) score.

Results

The average radial inclination was 21°, with 5.6° of volar tilt and 0.1 mm of radial shortening. The average range of motion were 42.6° of flexion, 56.5° of extension, 23.4° of radial tilt, and 24.8° of ulnar tilt. The average grip strength was 81.3% of the opposite side. The average VAS and DASH scores were 1.1 and 21.3, respectively.

Conclusion

In the case of sigmoid notch fracture involving dorsal lunate fossa depression fractures and distally displaced dorsal rim fractures, we were able to reduce and fix the fragment conveniently using limited dorsal approach.

Keywords: Distal radio-ulnar joint, Distal radius fracture, Limited dorsal approach, Lunate fossa depression fracture, Dorsal rim fracture

Figures and Tables

Fig. 1

Fifty six years female patient with distal radius fracture, fall on outstretched hand. Initial radiograph shows comminuted intra-articular distal radius fracture and dorsal fragment distal migration.

Fig. 2

Computed tomography shows dorsal fragment distal migration and sigmoid notch involvement.

Fig. 3

After volar plate and screw fixation, additional limited dorsal approach was done. After making 2 cm longitudinal incision, operation field is retracted with Senn retractor and silicon tube. Then, reduction is done using dura elevator.

Fig. 4

Final radiograph shows satisfactory result without sclerotic change in distal radioulnar joint and radio-carpal joint.

Fig. 5

The efficacy of limited dorsal approach, the limited dorsal approach makes it convenient to recover articular surface both distal radio-ulnar joint and radiocarpal joint.

Table 1

Demographic data

Values are presented as mean (range) or number.

DRUJ: distal radioulnar joint.

Table 2

Radiologic result

Values are presented as mean (range).

OP: operative.

Table 3

Clinical result (last follow up)

Values are presented as mean (range).

DASH: disabilities of the arm, shoulder and hand.

Notes

^{CONFLICTS OF INTEREST} The authors have nothing to disclose.

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