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A Hook-Plate Extension to a Volar Locking Plate to Address Volar Marginal Fragments of the Distal Radius
Jorge Luis Orbay, MD; Francisco Rubio, MD; Lauren Vernon, PhD
The Miami Hand and Upper Extremity Institute, Miami, FL
Introduction: Articular fractures of the distal radius may include a small fragment from the volar margin of the lunate fossa: volar marginal fragments (VMFs); these fragments are prone to loss of fixation, avascular necrosis and often result in wrist subluxation. Biomechanical studies have demonstrated that the centroid of force application is located palmarly on the lunate fossa and because the lunate fossa is offset in a palmar direction relative to the radial shaft, the VMF carries high loads and is difficult to stabilize. We present our experience using a hook-plate extension to a volar locking plate to manage acute VMF’s.
Materials and Methods: We retrospectively reviewed the records of all patients treated at our facility with a hook plate extension for a VMF. Medical charts were examined for complications and functional results. We treated 21 patients, 14 females and 7 males (ages 38-87, average 68.6 years ± 11.9 years), with a volar hook plate extension for management of a VMF (15 left wrists and 6 right wrists). Fracture fixation was obtained using the volar distal radius plate system with a hook plate attachment in a modular part of this system. Of the 21 patients treated, 17 used the hook plate extension during the primary reduction (1st surgery; 81.0%), and 4 used the hook plate extension during a secondary procedure for a failed volar marginal fragment (19.0 %).
Results: The hook plate extension was successful in reducing the VMF and maintaining reduction through final follow-up in 17 of the 17 patients treated primarily (100%). Of the four revision cases for failed VMFs, two failed to heal (50%).
Conclusion: We conclude that hook plate fixation of the VMF is an effective means of fixing the acute VMF. but failed in half of the cases when it was used for a secondary procedure. Other methods of treatment may be more appropriate for some failed VMF’s.
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