Distal Radius Fractures and the Volar Lunate Facet Fragment: Kirschner Wire Fixation in Addition to Volar-Locked Plating

Abstract

Background The volar lunate facet fragment of a distal radius fracture may not be stabilized with volar-locked plating alone due to the small size and distal location of the fragment. Identification and stabilization of this small fragment is critical as unstable fixation may result in radiocarpal and radioulnar joint subluxation. The addition of spring wire fixation with volar plating can provide stable internal fixation of this critical fracture fragment. Methods A retrospective review (2006)(2007)(2008)(2009)(2010)(2011) identified nine patients with distal radius fractures with an associated volar lunate facet fragment that were treated with volar-locked plating and spring wire fixation of the volar lunate facet fragment. Radiographic indices, range of motion, grip strength, and postoperative Patient-related wrist evaluation (PRWE) scores were obtained to assess pain and function. Results All distal radius fractures healed, and the volar lunate facet fragment reduction was maintained. The mean follow-up was 54 weeks. Mean active range of motion was 46°wrist flexion, 51°wrist extension, 80°pronation, and 68°supina-tion. The mean grip strength was 21 Kg, achieving 66 % of the uninjured limb. The average PRWE score was 17. No patient required removal of hardware or had evidence of tendon irritation. Conclusions The addition of spring wire fixation to volarlocked plating provided stable fixation of the volar lunate facet fragment of distal radius fractures without complication. This technique addresses a limitation of volar-locked plating to control the small volar lunate facet fragment in distal radius fractures otherwise amenable to volar plating. Level of Evidence A retrospective case series, Level IV.

Involvement of the palmar lunate facet in intra-articular distal radius fractures

“…Fragment-specific fixation systems are available [15,16]. Hook plate, Kirschner wires and osteosuture may be also suitable techniques [17,18]. In the case of a small palmar marginal rim fragment, fixation with a volar rim distal radius plate can be a valid treatment option [19].…”

“…Difficulty of fixation of the palmar lunate facet fragment has been recognized previously [1,2]. Stable fixation of a small palmar lunate facet fragment with a classical palmar plate alone can be insufficient and alternative fixation techniques may be necessary [15][16][17][18][19]. As the prevalence of palmar lunate facet fractures may be relatively high in intra-articular distal radius fractures, a preoperative CT-scan seems to be justified to help surgeons to decide which fixation technique is best to avoid secondary fracture displacement.…”

Volar Locking Plate Fixation for Intra-Articular Distal Radius Fractures with Volar Lunate Facet Fragments Distal to the Watershed Line

“…However, some studies reported reduction loss of VLF fragments in patients with distal radius fracture and small VLF fragments located very distal to the watershed line, even with the use of a distally placed volar locking plate 4,5,8,9,12 or absorbed, resulting in UV reduction loss (Fig. 5).…”

“…Several studies reported good clinical results and efficacy for distally placed plate fixation 4,5,8 11 . However, some studies noted reduction loss of the VLF fragment or distal radioulnar joint (DRUJ) instability in patients with small VLF fragments, even after treatment with a distally placed volar locking plate 4,5,8,9,12 . One study reported that a small, distally located VLF fragment could not be stabilized with volar distally placed locking plate fixation alone 12 .…”

Anatomical reduction and precise internal fixation of intra-articular fractures of the distal radius with virtual X-ray and 3D printing

“…Intra-articular DRF (IDRF), a severe form of DRF, accounts for about 25% of total DRF [3]. Currently, it is still very challenging to completely recover from the IDRF, because it is necessary to achieve not only an anatomical reduction [4,5], i.e., complete reconstruction of radius and the articular surface [6], but also a strong and precise internal fixation to facilitate early rehabilitation [7]; otherwise complications such as traumatic arthritis will often occur, which will seriously affect the function of the hands and wrists [8,9].…”