The volar rim of the distal radius is the only bony restraint to volar carpal subluxation.
Higher loads across the volar rim require stable and rigid fixation to maintain reduction
and allow healing while rehabilitation begins. Volar marginal fragments are not amenable
to buttressing by fixed angle volar locking plates. Appropriate management of volar
marginal fragments comprises two steps—recognition of their presence and rigid anatomical
repair. The best opportunity for success in the presence of a volar marginal fragment
is its adequate initial treatment. The purpose of this review is to reinforce the
importance of a complete preoperative and intraoperative evaluation of distal radius
fractures. Volar marginal fragments can easily be overlooked even following initial
reduction and fixation. Understanding the relevant anatomy and loading parameters
can facilitate intraoperative decisions on approach and fixation, which are integral
to achieving optimal clinical outcomes.
Keywords
distal radius fracture - fragment specific fixation - volar marginal fragments - volar
rim - watershed line
