Journal of Musculoskeletal Trauma

Open distal radius fracture with ulnar neurovascular injury treated with dorsal spanning plate fixation and vein interposition grafting: a case report: Kyeong-Eon Kim, Ho-Yong Lee, Shin-Woo Lee, Ji-Sup Kim; J Musculoskelet Trauma 2026;39(3):262-268. Published online July 20, 2026; DOI: https://doi.org/10.12671/jmt.2026.00164

Abstract PDF: Open comminuted intra-articular distal radius fractures with associated ulnar neurovascular injury are rare; furthermore, these injuries are challenging because skeletal stabilization, arterial reconstruction, nerve assessment, and soft-tissue coverage must be coordinated. We report the case of an 80-year-old female patient who presented after a fall from stairway with a severe open distal radius fracture and a volar-ulnar distal forearm wound. She reported numbness and tingling in the ring and small fingers, with a cold sensation and delayed capillary refill. Imaging showed a severely comminuted intra-articular distal radius fracture (AO/OTA type 23-C3). Emergency surgery was performed within 6 hours. First, a dorsal spanning plate was applied, and the small volar lunate facet fragment was fixed with a volar lunate facet plate. After debridement of the injured ulnar artery, a segmental defect remained and was reconstructed using a reversed basilic vein interposition graft harvested from the ipsilateral proximal forearm. The contused but continuous ulnar nerve was treated with neurolysis. The soft-tissue defect was managed with an acellular dermal matrix and negative-pressure wound therapy, followed by staged full-thickness skin grafting 1 week later. At 1 year postoperatively, bony union was achieved, and the functional outcomes were satisfactory. Level of evidence: V.

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Progressive forearm instability after anatomical union of a radial head fracture: a case report of a challenging Essex-Lopresti injury: SeongJu Choi; Received April 6, 2026 Accepted May 26, 2026 Published online July 20, 2026; DOI: https://doi.org/10.12671/jmt.2026.00157 [Epub ahead of print]

Abstract PDF: Essex-Lopresti injuries remain challenging because anatomical restoration of bony structures does not always re-establish functional forearm stability. We report the case of a 51-year-old male patient who sustained an elbow dislocation, comminuted radial head and neck fracture, and distal radioulnar joint (DRUJ) dissociation after falling from a bicycle. He underwent open reduction and internal fixation of the radial head, interosseous membrane augmentation using a suture-button construct, and temporary DRUJ pinning. Immediate postoperative radiographs showed apparent restoration of radial length, and radiographic union of the radial head was achieved. However, ulnar-sided wrist pain initially improved but progressively recurred by 6 months, with increasing ulnar-positive variance and DRUJ widening. Elbow motion was preserved, but forearm rotation was limited, and computed tomography demonstrated heterotopic ossification around the radial head. Ulnar shortening osteotomy and radial head arthrolysis were performed as a second procedure, after which mechanical instability developed, with irreducible anterior dislocation of the radial head. A third operation, consisting of annular ligament reconstruction using a palmaris longus autograft, restored proximal radioulnar joint stability, although substantial limitation of forearm rotation persisted. This case highlights that even radiographic union and multistructural initial management may fail to restore balanced forearm mechanics in Essex-Lopresti injury. Level of evidence: V.

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Radiocarpal subluxation after volar plating due to an insufficiently supported dorsal key fragment: a case report: Yeongyoon Koh, Kanghun Yu, Jong Woong Park, In Cheul Choi; J Musculoskelet Trauma 2026;39(3):269-274. Published online July 3, 2026; DOI: https://doi.org/10.12671/jmt.2026.00185

Abstract PDF: Distal radius fractures are commonly managed using volar locking plate fixation, which provides stable fixation in most cases. However, certain fracture patterns involving dorsal key fragments may not be adequately stabilized with a volar approach alone, even when intraoperative reduction appears satisfactory. We report the case of a 58-year-old male patient with a complex intra-articular distal radius fracture involving a dorsoulnar corner (DUC) fragment. Preoperative computed tomography revealed a dorsal fragment associated with subtle dorsal radiocarpal subluxation. Despite this finding, the fragment was considered amenable to fixation through a volar approach because it was relatively large. Although satisfactory reduction was achieved intraoperatively, early postoperative imaging demonstrated progressive dorsal radiocarpal subluxation due to displacement of the DUC fragment, while overall alignment parameters remained preserved. Revision surgery with additional dorsal buttress fixation successfully restored stability. This case highlights the critical importance of recognizing dorsal key fragments and achieving adequate dorsal support during fixation, as failure to provide sufficient support may result in delayed instability despite acceptable initial reduction. Level of evidence: V.

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Current concepts and applications of internal fixation for forearm diaphyseal fractures: Sung Yoon Jung, Min Kyun Cho, Dong-hee Kim, Sang Hyun Lee; J Musculoskelet Trauma 2026;39(3):205-215. Published online July 3, 2026; DOI: https://doi.org/10.12671/jmt.2026.00087

Abstract PDF: Adult diaphyseal fractures of the forearm functionally behave as intra-articular injuries because forearm rotation depends on accurate restoration of length, axial alignment, rotation, and the native radial bow. This narrative review summarizes contemporary surgical options for adult forearm shaft fractures, including 3.5-mm plate osteosynthesis, dual mini-plate fixation, interlocking intramedullary nailing, and minimally invasive plate osteosynthesis (MIPO). Compression plating with 3.5-mm plates remains the reference standard for most fracture patterns, whereas other techniques should be regarded as selective, emerging, or salvage options according to their indication spectrum and evidence base. Mini-fragment dual plating may be useful for short segments or thin soft-tissue envelopes, although the supporting clinical evidence remains limited and meticulous biomechanical execution is essential. Interlocking intramedullary nailing is a viable alternative for carefully selected simple fracture patterns or soft-tissue-compromised situations, offering less invasive exposure but a narrower indication spectrum. MIPO may be considered for selected comminuted or soft-tissue-compromised diaphyseal fractures; however, its use in adult forearm fractures remains constrained by the high functional requirement for precise restoration of length, rotation, and the radial bow. To improve transparency, this review explicitly distinguishes established, evidence-supported methods from techniques supported mainly by limited retrospective data or institutional experience. A pattern-based pragmatic algorithm and expanded comparison table are provided to guide fixation selection according to the bone involved, fracture location, fracture morphology, soft-tissue condition, and evidence tier while minimizing complications such as nonunion, infection, nerve injury, refracture after plate removal, and radioulnar synostosis.

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Epidemiological changes and surgical trends of distal radius fractures in adults over 50 years during the COVID-19 pandemic in Korea: a nationwide repeated cross-sectional study: Han-Kook Yoon, So Ra Yoon, Kee-Bum Hong, Youngsu Jung, SeongJu Choi, Jun-Ku Lee; J Musculoskelet Trauma 2026;39(1):12-19. Published online January 25, 2026; DOI: https://doi.org/10.12671/jmt.2025.00297

Abstract PDF Supplementary Material: Background
The COVID-19 pandemic is likely to have affected bone health in older adults in Korea. This study aimed to analyze changes in the epidemiology and management of distal radius fractures (DRFs) in older adults before and during the COVID-19 pandemic.
Methods
Patients with DRF aged over 50 years in 2017, 2018, 2020, and 2021 were included in this study. Patients were classified into a group with DRF occurring between 2017 and 2018 (before COVID-19) and a group with DRF occurring between 2020 and 2021 (during COVID-19). We calculated the incidence rates of DRF and compared them between the two groups. We also analyzed and compared demographic data (age, sex, income, residence) and the operation rate for DRF between the two groups. Patient selection and treatment were based on International Classification of Diseases, 10th revision codes.
Results
A total of 140,634 patients with DRF (before COVID-19, 69,794; during COVID-19, 70,840) were included. The incidence of DRF before COVID-19 (184.4/100,000 person-years) was higher than during COVID-19 (169.8/100,000 person-years). The operation rate was higher during COVID-19 (86.9%) than before COVID-19 (83.3%).
Conclusion
During the COVID-19 pandemic, the incidence of DRF decreased in South Korea. However, the rate of surgical treatment increased and exceeded the global surgical rate. Level of evidence: III.

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Surgical Treatment of Distal Radius Fractures and Treatment of Common Accompanying Lesions: Joo-Hak Kim; J Korean Fract Soc 2022;35(3):120-127. Published online July 31, 2022; DOI: https://doi.org/10.12671/jkfs.2022.35.3.120

Abstract PDF: There have been major advances in the treatment of distal radius fractures over the past 20 years. Specifically, the development of the volar locking plate in 2001 and the subsequent improvements in its design and performance have enabled the treatment of distal radius fractures that were previously considered difficult to treat. The volar plate is used for fractures and shows good results with anatomical reduction and firm fixation. However, when trying to apply it to more complex fractures, there are still difficulties related to the unique anatomical structure of the distal radius, and there are also several factors that can impair joint function and cause pain after surgery. In this review, the factors to be considered to ensure better outcomes during ORIF (open reduction and internal fixation), and external fixation in the treatment of distal radial fractures are described. The review also details the common accompanying injuries and management methods.

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