A small but significant fragment from the volar margin of the lunate fossa is occasionally present in complex distal radius fractures and agravates the prognosis. We present our experience in the management of this injury.

Methods:

We performed a retrospective review of all cases treated at our center for distal radius fractures between January 1999 and March 2002 with a significant volar marginal fragment. Different methods of fixation where used according to the surgeon’s choice. At final follow-up, standard radiographic fracture parameters were measured and final functional results where assessed by measuring digital motion, wrist motion and grip strength.

Results:

13 patients out of a total of 383 distal radius cases fit the inclusion criteria. One patient was lost to follow-up. We were able to follow 12 patients with 12 distal radius fractures for an average of 43 weeks. Fixation of the fragment was achieved using k-wires, screws, buttress support and subchondral support. Four patients were re-operated due to collapse of the volar marginal fragment; two of these fragments were unrecognized during the initial surgery. Final volar tilt averaged 12 deg., radial tilt 22 deg., articular displacement averaged 1mm. and radial shortening averaged <1 mm. The average final wrist extension was 55 deg., flexion 48 deg., pronation 81 deg. and supination 77 deg. Grip strength was 70% of the contra-lateral side.

Conclusion:

Distal radius fractures with a volar marginal fragment are rare, occurring in 3.39% of our cases. Recognition of the fragment is difficult as it often is non-displaced at presentation. Proper management of this lesion is essential and failure to do so will result in volar subluxation of the carpus.