Volar Capsular Release After Distal Radius Fractures.

Area of Science:

• Orthopedic Surgery
• Hand and Wrist Surgery
• Trauma Surgery

Background:

• Loss of wrist range of motion, particularly extension, is a common complication following distal radius fracture treatment.
• Volar plating for distal radius fractures can lead to stiffness, impacting functional activities.
• Wrist capsular release for stiffness is approached cautiously due to concerns about carpal instability.

Purpose of the Study:

• To evaluate the efficacy and safety of hardware removal combined with open volar capsular release for restoring wrist function.
• To test the hypothesis that this combined surgical approach would not improve patient-reported outcomes (DASH scores).

Main Methods:

• Retrospective review of patients undergoing flexor carpi radialis tenolysis, hardware removal, and subperiosteal volar capsular release.
• Primary outcome: Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire scores.
• Secondary outcomes: Range of motion (flexion, extension, pronation, supination), pain (VAS), and radiographic assessment of ulnocarpal translocation.

Main Results:

• Eleven patients with a mean follow-up of 4.5 years showed significant improvement in DASH scores post-surgery.
• Mean wrist flexion, extension, pronation, and supination all improved.
• No significant changes in visual analog scale for pain; normal radiocarpal relationships observed on imaging.

Conclusions:

• Open volar capsular release with hardware removal is a safe and effective treatment for regaining wrist extension after distal radius fractures treated with volar locking plates.
• The procedure leads to improved functional outcomes, indicated by higher DASH scores.
• No radiographic or clinical evidence of ulnocarpal translocation was noted after releasing the volar extrinsic ligaments.