Functional Improvement with Digital Prosthesis Use After Multiple Digit Amputation

ABSTRACT

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

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

Thirteen patients of 383 distal radius fractures cases fit the inclusion criteria. One patient was lost to follow-up. Twelve patients with 12 distal radius fractures underwent average 43-week follow-up. Fragment fixation was achieved using Kirschner wires, screws, buttress support, and subchondral support. Four patients were reoperated due to collapse of the volar marginal fragment; 2 fragments were unrecognized during the initial surgery. Final volar tilt averaged 12º, radial tilt 22º, articular displacement 1 mm, and radial shortening <1 mm. The average final wrist extension was 55º, flexion 48º, pronation 81º, and supination 77º. Grip strength was 70% of the contralateral side.

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 nondisplaced at presentation. Proper management of this lesion is essential and failure to do so results in carpus volar subluxation.