JHS - 2026-08-20 - Journal Article
Distal Radius Articular Surface Visualization: Comparison of Ligament-Sparing Volar and Dorsal Radiocarpal Arthrotomies for Distal Radius Fracture Reduction.
Rakowski DR, Richman EH, Kahan R, Peek KJ, France TJ, Swartwout H, Rogers M, Leversedge FJ, Lauder A
Topics
Key Takeaway
Dorsal ligament-sparing radiocarpal arthrotomy visualizes 77.3% of the distal radius articular surface versus 63.7% via volar arthrotomy, a statistically significant 13.5% difference (P=.008).
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Summary
This cadaveric study quantified articular surface visualization through ligament-sparing volar versus dorsal radiocarpal arthrotomies using photogrammetric 3D modeling. Dorsal arthrotomy provided 77.3% total articular surface visualization versus 63.7% via volar arthrotomy (P=.008). Overlay mapping demonstrated complementary regional strengths: volar arthrotomy optimized volar rim exposure, while dorsal arthrotomy improved visualization of the dorsal rim, dorsal-radial scaphoid facet, and dorsal-ulnar lunate facet.
Key Limitation
Cadaveric specimens without simulated fracture patterns cannot account for how fracture displacement, comminution, and intraoperative bleeding alter effective visualization percentages in clinical practice.
Original Abstract
PURPOSE
Direct articular surface visualization may improve reduction accuracy in intra-articular distal radius fractures. A ligament-sparing volar radiocarpal arthrotomy has been described to complement the standard volar approach, but the articular surface area (SA) visualized has not been compared to the traditional dorsal radiocarpal arthrotomy. This study quantified and compared articular SA visualization through volar and dorsal ligament-sparing radiocarpal arthrotomies in a cadaveric model.
METHODS
Twenty-four fresh-frozen cadaveric specimens (12 matched pairs) underwent either a volar or dorsal ligament-sparing radiocarpal arthrotomy; one wrist from each pair was randomized to each approach. Visible articular SA was calculated using photogrammetric three-dimensional models created using postarthrotomy images. Radiocarpal disarticulation was performed to calculate total articular SA. Total SA percentage was compared using paired t tests. Regional articular visualization was characterized for each approach by overlay mapping.
RESULTS
Mean percentage of SA visualization was 63.7% (range, 43.9% to 90.7%) via volar radiocarpal arthrotomy and 77.3% (range, 53.1% to 90.9%) via dorsal radiocarpal arthrotomy; the dorsal arthrotomy provided a mean increase in visualization of 13.5% (P = .008). Based on overlay mapping, the volar arthrotomy improved visualization of the volar rim, whereas dorsal arthrotomy improved visualization of the dorsal rim, dorsal-radial scaphoid facet, and dorsal-ulnar lunate facet. There was similar visualization of the central third of the radius, volar-radial scaphoid facet, and volar-ulnar lunate facet.
CONCLUSIONS
Both volar and dorsal arthrotomies provide excellent visualization of the distal radius articular surface, although dorsal arthrotomy provided greater overall visualization. Volar arthrotomy improved exposure of the volar rim, a region commonly involved in volar rim marginal fractures and volar shear intra-articular fractures. The dorsal arthrotomy allowed regional visualization of fracture patterns involving the dorsal-radial styloid, dorsal-ulnar lunate facet, or dorsal rim articular comminution.
CLINICAL RELEVANCE
Radiocarpal arthrotomies provide a practical direct assessment of the distal radius articular surface without additional incisions or arthroscopic resources.