Original Article The Journal of Hand Surgery (Asian-Pacific Volume) 2017;22(2):184-187 • DOI: 10.

1142/S0218810417500228

Midterm Follow-up of Treating Volar

Marginal Rim Fractures with Variable
Angle Lcp Volar Rim Distal Radius Plates
Chul Ki Goorens*,†, Stijn Geeurickx*,†, Pascal Wernaers*, Barbara Staelens†,
Thierry Scheerlinck†, Jean Goubau†
*Department of Orthopaedics and Traumatology, Regional Hospital Tienen, Kliniekstraat, Tienen,
†
Department of Orthopaedics and Traumatology, Vrije Universiteit Brussel (VUB),
J Hand Surg Asian-Pac Vol 2017.22:184-187. Downloaded from www.worldscientific.com

Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium

by THE UNIVERSITY OF HONG KONG on 05/21/17. For personal use only.

Background: Specific treatment of the volar marginal rim fragment of distal radius fractures avoids occurance of volar radiocar-
pal dislocation. Although several fixation systems are available to capture this fragment, adequately maintaining internal fixation
is difficult. We present our experience of the first 10 cases using the 2.4 mm variable angle LCP volar rim distal radius plate (Depuy
Synthes®, West Chester, US), a low-profile volar rim-contouring plate designed for distal plate positioning and stable buttressing
of the volar marginal fragment.
Methods: Follow-up patient satisfaction, range of motion, grips strength, functional scoring with the QuickDASH and residual pain
with a numeric rating scale were assessed. Radiological evaluation consisted in evaluating fracture consolidation, ulnar variance,
volar angulation and maintenance of the volar rim fixation.
Results: The female to male ratio was 5:5 and the mean age was 52.2 (range, 17–80) years. The mean follow-up period was 11 (range,
5–19) months postoperatively. Patient satisfaction was high. The mean total flexion/extension range was 144° (range, 100–180°)
compared to the contralateral uninjured side 160° (range, 95–180°). The mean total pronation/supination range was 153° (range,
140–180°) compared to the contralateral uninjured side 170° (range, 155–180°). Mean grip strength was 14 kg (range, 9–22), com-
pared to the contralateral uninjured side 20 kg (range, 12–25 kg). Mean pre-injury level activity QuickDASH was 23 (range, 0–34.1),
while post-recovery QuickDASH was 25 (range 0–43.2). Residual pain was 1.5 on the visual numerical pain rating scale. Radiological
evaluation revealed in all cases fracture consolidation, satisfactory reconstruction of ulnar variance, volar angulation and volar rim.
We encountered no flexor tendon complications, although plate removal was systematically performed after fracture consolidation.
Conclusions: The 2.4 mm variable angle LCP volar rim distal radius plates is a valid treatment option for treating the volar mar-
ginal fragment in distal radius fractures.

Keywords: Distal radius fractures, Volar rim

INTRODUCTION
Received: Dec. 31, 2015; Revised: Apr. 24, 2016; Accepted: May 8, 2016
Correspondence to: CK Goorens Volar plating is currently probably the most popular
Department of Orthopaedics and Traumatology, Regional Hospital Tienen, surgical option for treatment of distal radius fractures.
Kliniekstraat 45, 3300 Tienen, Belgium Different fracture patterns can be addressed.1)
Tel: +3216809797, Fax: No fax number available Inadequate reconstruction of an unstable volar mar-
E-mail: [email protected] ginal rim fragment provokes volar radiocarpal disloca-
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The Journal of Hand Surgery (Asian-Pacific Volume) • Vol. 22, No. 2, 2017 • www.jhs-ap.org

tion.2) Although several fixation systems are available to terprises Inc., New York, USA), functional scoring with
capture this fragment, adequately maintaining internal the QuickDASH, residual pain with a numeric rating
fixation is difficult. Fragment-specific wireforms and scale (0 = no pain, 10 = severe pain) were all measured
other constructs are difficult to place and may have lim- by the first and second author. Radiological evaluation
ited resistance to bending and axial load. Fixed-angle consisted in evaluating fracture consolidation, ulnar vari-
volar plates have limited positioning possibility for distal ance, volar angulation and maintenance of the volar rim
translation beyond the watershed line, without increasing fixation.
the risk of flexor tendon rupture.3-7) The first 10 patients with distal radius fractures with
We present our experience of the first 10 cases using complete articular involvement, AO type C fractures of
the 2.4 mm variable angle LCP volar rim distal radius the distal radius (all of which presented with a distal vo-
plate (Depuy Synthes®, West Chester, US), a low-profile lar lunate facet/volar rim fragment) were operated from
volar rim-contouring plate designed for distal plate posi- April 2013 to August 2014. The female to male ratio was
tioning and stable buttressing of the volar marginal frag- 5:5 and the mean age was 52.2 (range, 17–80) years.
J Hand Surg Asian-Pac Vol 2017.22:184-187. Downloaded from www.worldscientific.com

ment. Average follow-up from surgery to their last follow-up

by THE UNIVERSITY OF HONG KONG on 05/21/17. For personal use only.

was 11 (range, 5–19) months. Nine of the patients were

METHODS right-hand dominant and 1 was left-hand dominant. All
patients received a 2.4 mm variable angle LCP volar rim
Fracture types were assessed by radiographs and distal radius plate, fixed distally with locking screws and
mostly a supplementary CT-scan to improve visualiza- proximally with one cortical and at least 2 supplementa-
tion of intra-articular fragmentation. All patients were ry locking screws in the shaft of the plate. In one patient,
operated by a senior hand surgeon, using the 2.4 mm additional screws were metaphyseally placed separate
variable angle LCP volar rim distal radius plate. After- from the plate to reduce cortical fragmentation (Fig. 1–5).
care consisted of 10 days of volar splinting. Automobili- In one patient, 2 dorsal plates were placed to fix the dor-
sation was instructed after 10 days and physiotherapy sal rim to counter residual dorsal radiocarpal instability.
after 6 weeks if insufficient mobility was measured. In one patient, a radial plate was placed to reduce the
Postoperative assessment was performed after a minimal radial styloid and kirchner wires to fix the scapholunate
of 5 months. Patient satisfaction was questioned and dissociation. In two patients, radiocarpal wrist arthros-
answers were graded as satisfied, intermediate and non- copy was performed additionally to reduce the die punch
satisfied. Total flexion/extension and pronation/supina- fragment. In one patient, a standard volar plate, which
tion range of motion, grip strength using a calibrated was initially placed proximal to the watershed line, was
hydraulic hand dynamometer (Baseline Fabrication En- exchanged for a volar rim plate, due to a second fall

Fig. 1. Preoperative CT-scan profile view: dorsally displaced distal radius Fig. 2. 10-days postoperative radiograph AP view: reduced distal radius
fracture with volar marginal rim fragmentation. fracture fixed with volar rim plate.
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Chul Ki Goorens, et al. Volar Marginal Rim Fractures
J Hand Surg Asian-Pac Vol 2017.22:184-187. Downloaded from www.worldscientific.com
by THE UNIVERSITY OF HONG KONG on 05/21/17. For personal use only.

Fig. 3. 10-days postoperative radiograph lateral view: reduced distal Fig. 4. 4-months postoperative radiograph AP view: consolidated distal
radius fracture fixed with volar rim plate. radius fracture after plate removal.

resulting in secondary volar radiocarpal dislocation. Al-

lobone graft was used in none of the patients.

RESULTS

All patients graded their satisfaction as satisfied. The

mean total flexion/extension range was 144° (range,
100–180°) compared to the contralateral uninjured side
160° (range, 95–180°). The mean total pronation/supi-
nation range was 153° (range, 140–180°) compared to
the contralateral uninjured side 170° (range, 155–180°).
Mean grip strength was 14 kg (range, 9–22), compared
to the contralateral uninjured side 20 kg (range, 12–25
kg). Mean pre-injury level activity QuickDASH was 23
(range, 0–34.1), while post-recovery QuickDASH was
25 (range, 0–43.2). Residual pain was 1.5 on the numeric
rating scale. Restoration of subjective and clinical ob- Fig. 5. 4-months postoperative radiograph lateral view: consolidated
jective wrist stability was obtained, with disappearance distal radius fracture after plate removal.
of visual wrist deformity. Last follow-up radiological
evaluation revealed in all cases fracture consolidation, DISCUSSION
mean ulnar variance 0 mm (range, -2 mm–0 mm), mean
volar angulation 8° (range, 0–15°) and maintenance of The rationale for the 2.4 mm LCP volar rim plate is
the volar rim fixation. to allow to buttress the volar rim and to minimize po-
We encountered no flexor tendon ruptures or carpal tential flexor irritation/rupture, if placement beyond the
tunnel syndrome, although preventive plate removal was watershed line is required in case of marginal rim frac-
systematically performed after 4 months when fracture tures. Soong et al. pointed out the importance of distal
consolidation was radiologically confirmed. Only one standard volar plate positioning in reference to the volar
out of ten patients had some minor flexor pollicis longus rim increasing the risk for tendon rupture, so standard
tendinopathy complaints at time of plate removal, which volar plates are preferably avoided for marginal rim frac-
disappeared after removal. To date, no loss of reduction tures.7)
or other complications were noted. Bakker et al. described the absence of flexor tendon
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The Journal of Hand Surgery (Asian-Pacific Volume) • Vol. 22, No. 2, 2017 • www.jhs-ap.org

problems using an alternative ulnar fragment specific DISCLOSURE

narrow plate design, avoiding the radial-sided tendons,
but if the fragments are too small or comminuted, the use No benefits in any form have been received or will
of this device is contraindicated and alternative methods be received from a commercial party related directly or
to address the volar ulnar fragment are necessary.8) This indirectly to the subject of this article.
makes such implant maybe less applicable for all trauma
surgeons. Advantages of the volar rim plate that we used REFERENCES
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mm LCP volar rim plate in marginal rim fractures seems gian orthopaedic surgeons. Acta Orthopaedica Belgica.
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since it authorizes completely precontouring of the volar 2. Harness NG, Jupiter JB, Orbay JL, et al. Loss of fixation of
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Our results demonstrate that 2.4 mm variable angle
LCP volar rim distal radius plates provides reproduce-
able satisfactory outcome with exercise-stable fixation
and rapid recovery as standard volar locking plates.