Clinical Outcomes in Distal Radius Fractures Accompanied by Volar Lunate Facet Fragments: A Comparison between Dorsal and Volar Displaced Fractures

Abstract

Background: The treatment strategy for distal radius fractures accompanied by volar lunate facet fragment is controversial. In most cases, only the bone fragment size was discussed and a plate for distal placement is selected due to the accompanying volar lunate facet fragment regardless of the direction of bone fragment displacement. In this study, we divided distal radius fractures accompanied by volar lunate facet fragment into dorsal and volar displaced fractures, and treated these surgically based on different treatment strategies. Methods: The subjects were 25 patients with distal radius fractures accompanied by volar lunate facet fragment treated by reduction and fixation using a volar locking plate (VLP) (male: 14, female: 11, mean age: 57.8 years old). A proximal VLP (PVLP) was selected for 13 dorsal displaced fractures and a distal VLP (DVLP) was selected for 12 volar displaced fractures. The range of motion, VAS, Q-DASH, and Mayo score were evaluated at 12 months after surgery, and compared. Results: No significant difference due to the difference in the direction of displacement was noted in the range of motion, VAS, Q-DASH, or Mayo score at 12 months after surgery and there were no perioperative complications. In addition, no re-displacement of volar lunate facet fragment was noted after surgery in any patient and bone fusion was observed. Conclusions: Reduction and fixation with a PVLP are possible even for dorsal displaced distal radius fractures accompanied by volar lunate facet fragment. For the volar displaced distal radius fractures, a favorable postoperative outcome is possible by applying a DVLP to the distal ulnar.

Risk Factors for the Incidence of the Volar Lunate Facet Fragments in Distal Radius Fractures

“… 3 14 15 We used Obata et al's VLF definition, which was a length of 10 mm or less. 10 To avoid postoperative VLF displacement, the position of volar locking plates should be as distal and ulnar as possible for VLF coverage. Izawa et al showed that the plate should cover more than 65% of the VLF volar cortex to prevent postoperative fixation failure.…”

“…A previous study defined VLF as a VLF fragment that has a volar cortex length of less than 10 mm from the distal edge on a sagittal CT slice, which is cut 5 mm radial from the ulnar edge of the distal radius. 10 Evaluation of the anteroposterior (AP) radiograph is shown in ►Fig. 1.…”

Comparison of clinical outcomes with and without volar lunate facet fragments in dorsal displaced distal radius fractures

“…The subjects were 122 patients with dorsal-displaced DRFs treated by reduction and fixation using PVLP (42 males and 80 females, mean age: 59.2 years old) between January 2012 and December 2018. In the distal fragments of the distal radius fractures, the free bone fragments in the volar lunate facet fragment in which the longitudinal diameter of the volar bone cortex is 10 mm or less are defined as the volar lunate facet fragment [16]. The patients were divided into 13 patients with VLFF (VLFF (+) group: 9 males and 4 females, mean age: 60.0 years old) and 109 patients without VLFF (VLFF (À) group: 33 males and 76 females, mean age: 59.2 years old), and the clinical outcomes at 12 months after surgery were compared.…”