Scientific articleVolar Capsular Release After Distal Radius Fractures
Section snippets
Methods
After obtaining institutional review board approval, we completed a retrospective chart review of patients surgically treated, by a single surgeon (D.S.R.), for wrist extension loss after volar plating for a distal radius fracture. Because the clinical indication for this procedure was loss of functional wrist motion, the primary outcome measure was patient-reported disability using the DASH score. Secondary outcomes included degrees of improvement in wrist flexion, extension, pronation,
Results
We reviewed 14 charts and found 11 patients that met the inclusion criteria during the study period (Table 1). Average age was 45 years (range, 21–62 years). Mean follow up was 4.5 years and median follow up was 4.1 years (range, 1.8–8.2 years). There were no reports of a clunk, snap, or patient-reported instability.
Discussion
Postoperative wrist stiffness can occur after fixation of distal radius fractures. Although stiffness with loss of functional wrist extension is uncommon, there is limited literature to guide management of this complication. Verhellen and Bain30 previously reported arthroscopic release of the volar capsule in 2 patients. This study reported on the safety of this approach to neighboring structures, along with improved wrist ROM, grip strength, and pain at 6 months after surgery We report the
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2022, Journal of Orthopaedic ScienceCitation Excerpt :However, there are risks associated with the procedure, including injury to nerves, vessels, and tendons that exist outside the joint and wrist instability (ulnar translation of the carpal bone) [18,19]. Kamal et al. reported that after volar plating for distal radial fracture, 11 patients treated with open volar capsular release combined with tenolysis of the FCR and removal of hardware achieved 60.6° of wrist motion without ulnocarpal translation [20]. When arthroscopic release including the capsule and septum is not enough to resolve the contracture, an open procedure can be a feasible treatment for removal of the extrinsic causes.
Ligament-Sparing Volar Radiocarpal Arthrotomy During Distal Radius Fracture Repair: Biomechanical Implications on Wrist Stability in a Cadaveric Model
2022, Journal of Hand SurgeryCitation Excerpt :Clinically, the loss of wrist extension is a reported complication after operative fixation of DR fractures.20 Contracture management with plate removal and open volar capsular release has shown promising results without clinical evidence of carpal instability at follow-up.20 In our study, we expanded upon the findings of previous studies and evaluated a ligament-sparing approach for exposure and visualization of the radiocarpal joint, which may provide an opportunity for meaningful articular assessment during volar plate fixation of the DR. The biomechanical findings of the current study support the use of a volar radiocarpal arthrotomy with partial sectioning and subsequent repair of the LRL and SRL ligaments, with or without dorsal radiocarpal ligamentous disruption.
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