Ultrasound-Guided vs. Conventional Dorsoulnar Fragment Reduction Combined With Volar Locking Plate Fixation for...

Distal radius fractures (DRFs) are among the most common traumatic injuries. Reduction of dorsoulnar fragments combined with volar locking plate fixation yields satisfactory outcomes. However, conventional fluoroscopy-guided techniques present inherent limitations in accuracy. This study aimed to evaluate the feasibility and efficacy of ultrasound-guided reduction of dorsoulnar fragment (DUF) combined with volar locking plate fixation for DRFs.

This retrospective study included 116 patients with DRFs who underwent reduction of dorsoulnar fragments combined with volar locking plate fixation at our hospital between January 2022 and January 2024. Patients were allocated into two groups based on the intraoperative guidance technique: the observation group (n = 54, ultrasound-guided) and the control group (n = 62, X-ray-guided). Surgical indicators, healing progress, and outcome measures were assessed, including wrist function (Gartland-Werley score), range of motion (dorsiflexion, volar flexion, supination, pronation), radiological parameters (volar tilt, radial inclination, radial height), Visual Analog Scale (VAS) score, Modified Mayo Wrist Score (MMWS), grip strength, and complications.

Baseline characteristics and all preoperative outcome metrics (Gartland-Werley score, range of motion, radiological parameters, VAS score, MMWS, grip strength) showed no significant differences between the two groups (p > 0.05). The observation group demonstrated significantly shorter operation time, less intraoperative blood loss, and reduced hospital stay compared to the control group (p < 0.05). No significant difference in fracture healing time was observed (p > 0.05). Postoperatively, both groups exhibited significant reductions in Gartland-Werley scores (p < 0.001), with lower scores in the observation group (p < 0.001). Dorsiflexion, volar flexion, pronation, and supination angles significantly improved in both groups (p < 0.001); the observation group demonstrated larger dorsiflexion, pronation and supination angles (p < 0.001), but no intergroup difference was observed in volar flexion (p > 0.05). The radiological outcomes improved significantly in both groups postoperatively (p < 0.001). The observation group achieved superior volar tilt and radial height (p < 0.001), while radial inclination showed no significant difference (p > 0.05). The complication rate was significantly lower in the observation group than in the control group (p < 0.05).

Ultrasound-guided reduction of dorsoulnar fragments combined with volar locking plate fixation significantly enhanced postoperative wrist function, anatomical alignment, and reduced complication rates compared to conventional X-ray guidance. These findings suggest that intraoperative ultrasound is a valuable adjunct for dorsoulnar fragment (DUF) reduction in DRF fixation, contributing to greater precision and improved clinical outcomes.