OPERATIVE TREATMENT OF VOLAR INTRAARTICULAR FRACTURES OF THE DISTAL END OF THE RADIUS

We retrospectively reviewed the results of operative treatment of fort y-nine volar marginal intra-articular fractures of the distal end of t he radius. According to the Comprehensive Classification of Fractures, there were two B3.1 fractures (characterized by a small volar fragmen t, with the sigmoid notch intact), three B3.2 fractures (characterized by a large volar fragment that included the sigmoid notch), and forty -four B3.3 fractures (characterized by comminution of the volar fragme nt). Although all fractures healed and only nine patients had evidence of osteoarthrosis on follow-up radiographs, there were six early and fourteen late complications, some of which adversely influenced the ov er-all outcome, After an average of fifty-one months (range, twenty-fo ur to 117 months), there were thirty-one excellent, ten good, and eigh t fair results according to the system described by Gartland and Werle y, and thirty-two excellent, nine good, five fair, and three poor resu lts according to the modified system of Green and O'Brien. Two factors were found to have a significant association with a fair or poor outc ome: evidence of osteoarthrosis on the most recent follow-up radiograp hs and reversal of the normal volar tilt of the distal end of the radi us. The age of the patient, the interval from the injury to the operat ion, a concomitant injury of the ipsilateral upper extremity, an assoc iated fracture of the ulnar styloid process, the radio-ulnar index, ul nar angulation, the classification of the fracture, comminution of the volar fragment, and articular incongruity were not significantly asso ciated with the outcome.