Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 26, 2021; 9(24): 7022-7031
Published online Aug 26, 2021. doi: 10.12998/wjcc.v9.i24.7022
Influence of volar margin of the lunate fossa fragment fixation on distal radius fracture outcomes: A retrospective series
Hua Meng, Jia-Zhi Yan, Bing Wang, Zong-Bo Ma, Wei-Bo Kang, Bao-Ge Liu
Hua Meng, Jia-Zhi Yan, Bing Wang, Zong-Bo Ma, Wei-Bo Kang, Bao-Ge Liu, Department of Orthopedic Surgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China
Author contributions: Meng H and Yan JZ designed and supervised the study, analyzed the data, made the revisions to the manuscript, and designed the experiments; Meng H, Yan JZ, Ma ZB, Kang WB, and Liu BG performed the experiments; Meng H and Ma ZB wrote the manuscript; all authors reviewed the results and approved the final version of the manuscript.
Supported by High Levels of Health Technical Personnel in Beijing City Health System, No. 2013-3-050.
Institutional review board statement: The study was approved by the institutional review board (IRB) of Beijing Tiantan Hospital, Capital Medical University (No. KY 2018-005-02).
Informed consent statement: The IRB waived the requirement for informed consent.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jia-Zhi Yan, MD, Doctor, Department of Orthopedic Surgery, Beijing Tiantan Hospital, Capital Medical University, No. 119 South Fourth Ring West Road, Fengtai District, Beijing 100050, China. beijingtiantan@163.com
Received: March 11, 2021
Peer-review started: March 11, 2021
First decision: April 4, 2021
Revised: May 13, 2021
Accepted: July 5, 2021
Article in press: July 5, 2021
Published online: August 26, 2021
Processing time: 165 Days and 16.8 Hours
Abstract
BACKGROUND

Distal radius fractures accompanied by the volar margin of the lunate fossa (VMLF) lesions are often overlooked or inadequately reduced in clinical practice.

AIM

To investigate the impact of VMLF fragment in distal radius fractures on the stability and function of the wrist joint.

METHODS

This was a retrospective study of patients with distal radius fractures who underwent surgical treatment between January 2013 and December 2017. The patients were divided into two groups according to whether the VMLF fragments were fixed or not. X-rays and computed tomography were performed before surgery, immediately postoperatively, and at 1, 3, and 6 mo to measure the scapholunate angle, radiolunate angle, capitolunate angle, and effective radiolunate flexion (ERLF). The Mayo wrist score and disabilities of the arm, shoulder, and hand (DASH) score were determined at 1 year.

RESULTS

Thirty-five patients were included. There were 15 males and 20 females. Their mean age was 52.5 ± 14.3 (range: 19-70) years. There were 38 wrists (17 on the left side, 15 on the right, and three bilateral; 16 in the fixed group, and 22 in the unfixed group). The interval between trauma and surgery was from 1 h to 1 mo. The incidence of postoperative wrist instability in the unfixed group (86.4%) was higher than in the fixed group (25.0%) (P ≤ 0.001). Ten patients had ERLF > 25° in the unfixed group and none in the fixed group (P = 0.019). The Mayo wrist score was 94 ± 5.7 in the fixed group and 68 ± 15.1 in the unfixed group (P < 0.001). The DASH score was 4.6 ± 2.5 in the fixed group and 28.5 ± 19.5 in the unfixed group (P < 0.001).

CONCLUSION

Injuries of VMLF, even small fractures, might damage the radial-lunar ligament, leading to postoperative wrist instability, sagittal force line imbalance, and poor recovery of wrist joint function.

Keywords: Radius fractures; Lunate bone; Reduction; Disability; Wrist function

Core Tip: This study aimed to examine the impact of volar margin of the lunate fossa fragment in distal radius fractures on the stability and function of the wrist joint. The results suggested that the number of patients with pathological carpal malalignment in the unfixed group was significantly higher than that in the fixed group. All cases in the fixed group had an excellent/good functional outcome. In the unfixed group, six of 22 cases had an excellent/good outcome, and 16 of 22 cases had a fair-poor functional outcome.