Volar marginal rim fractures of the distal radius

The majority of distal radius fractures requiring surgery can be fixed by conventional techniques. Injuries to the volar marginal rim of the distal radius – occurring past the ‘watershed line’ are often high energy, involving small avulsion fragments containing the volar radiocarpal ligaments, therefore potentially destabilizing the carpus and the distal radioulnar joint. Successful management of these fractures involving a detailed understanding of the anatomy of the fracture, surgical approach, and fixation techniques. The injury may be overlooked by the inexperienced surgeon. Volar marginal rim fractures can be one of five types; 1 – a volar ulnar corner fracture (VUC) as an isolated fragment, 2 – VUC fragment with extension radially to involve the radiocarpal ligaments (the entire volar rim), 3 –VUC fragment as one component of a metaphyseal fracture, 4 - VUC fragment as part of a high energy “pilon-type” fracture, or 5 – in combination with a greater arc injury. Standard locking volar distal radius plates often provide inadequate support and fixation to this fragment and each subtype requires separate consideration for management. In this chapter we will outline these injuries. We will discuss treatment principles including imaging, surgical approach and fixation techniques to ensure satisfactory treatment of this injury.