Article

Intra-articular distal radial fractures in young subjects occur in
severe trauma. Articular reduction needs to be anatomical. We report four cases
with the particularity of having a 90 degrees or 180 degrees rotated lunate
fossa. Our goal is to bring out the positive aspects of surgical procedure by
volar medial approach and to assess long-term functionnal and radiological
results. METHODS: Our study focused on four men whose average age
was 27 (age range from 19 to 43). The fractures were type IV according to
Melone's classification. The associated lesions included: one fracture of the
base of the ulnar styloid, one fracture of the distal quarter of the ulnar
diaphysis and one scapho-lunate diastasis. We used a volar medial approach
between the flexors tendons and the ulnar bundle in order to pin the fragment of
lunate fossa. The rest of the radial epiphysis was pinned after a 5mm skin
incision. In two cases, this pinning was complemented with a
brachial-antebrachial-palmar cast and in the other two cases with an external
fixator. RESULTS: The follow-up period averaged 68.8 (18 to 115) months, all the
patients were clinically examined through antero-posterior, lateral and dynamic
X-rays. The objective results assessed according to Green and O'Brien's criteria,
later modified by Cooney, were as follows: two very good, one good, one average.
The X-rays showed consolidated fractures. According to Knirk and Jupiter's
classification of arthritis, we had three grades 0, one of which showed a
subchondral sclerosis of the lunate fossa, and one grade 3. DISCUSSION AND
CONCLUSION: Imaging with simple radiographs is not sufficient and needs to be
complemented with CT scan. Our approach allows for direct access to the fragment
of the lunate fossa and easier visualization of the distal radioulnar, compared
to Henry's approach, thereby avoiding excessive traction of the median nerve.
TYPE D'ETUDE: Niveau IV.
CI - Copyright (c) 2013. Published by Elsevier SAS.

Langue : FRANCAIS