Arch Hand Microsurg.  2018 Sep;23(3):150-157. 10.12790/ahm.2018.23.3.150.

Limited Dorsal Approach for Intra-Articular Distal Radius Fracture Involving the Sigmoid Notch

  • 1Department of Orthopedic Surgery, Duson Hospital, Ansan, Korea.
  • 2Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Korea.


The purpose of this study was to analyze the 16 patients, with distal radius fracture involving sigmoid notch fracture, who were treated by limited dorsal approach retrospectively.
Between June 2003 and December 2013, 743 patients with distal radius fracture underwent operative treatment. Among them, 16 patients received conventional treatment, with additional limited dorsal approach. The fracture patterns involved sigmoid notch with dorsal lunate fossa depression, as well as distally displaced dorsal rim fragment. Radiologic results were evaluated based on dorsal tilt, radial inclination, and radial shortening. Clinical results were evaluated based on grip strength, motion range of the wrist joint, arm disabilities, shoulder & hand (DASH) score, and visual analogue scale (VAS) score.
The average radial inclination was 21°, with 5.6° of volar tilt and 0.1 mm of radial shortening. The average range of motion were 42.6° of flexion, 56.5° of extension, 23.4° of radial tilt, and 24.8° of ulnar tilt. The average grip strength was 81.3% of the opposite side. The average VAS and DASH scores were 1.1 and 21.3, respectively.
In the case of sigmoid notch fracture involving dorsal lunate fossa depression fractures and distally displaced dorsal rim fractures, we were able to reduce and fix the fragment conveniently using limited dorsal approach.


Distal radio-ulnar joint; Distal radius fracture; Limited dorsal approach; Lunate fossa depression fracture; Dorsal rim fracture

MeSH Terms

Colon, Sigmoid*
Hand Strength
Radius Fractures*
Range of Motion, Articular
Retrospective Studies
Wrist Joint


  • Fig. 1 Fifty six years female patient with distal radius fracture, fall on outstretched hand. Initial radiograph shows comminuted intra-articular distal radius fracture and dorsal fragment distal migration.

  • Fig. 2 Computed tomography shows dorsal fragment distal migration and sigmoid notch involvement.

  • Fig. 3 After volar plate and screw fixation, additional limited dorsal approach was done. After making 2 cm longitudinal incision, operation field is retracted with Senn retractor and silicon tube. Then, reduction is done using dura elevator.

  • Fig. 4 Final radiograph shows satisfactory result without sclerotic change in distal radioulnar joint and radio-carpal joint.

  • Fig. 5 The efficacy of limited dorsal approach, the limited dorsal approach makes it convenient to recover articular surface both distal radio-ulnar joint and radiocarpal joint.


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