Volar plate fixation in intra-articular distal radius fractures with a volar lunate facet fragment

Classification and Management of Failed Fixation of the Volar Marginal Fragment in Distal Radius Fractures

“…We use the principles developed for the acute fractures. 2,4,5,7 As further delay will compromise the outcome, it is best to proceed expeditiously with revision surgery once the concerns have been identified. The surgeon should focus on adequate exposure, stable fixation, and give strong consideration to the use of a neutralization device such as a bridge plate.…”

“…10 Several methods have been described to stabilize a VMF that cannot be adequately addressed with the buttressing surface of a VLP: K-wires, small screws, tension bands, hook plates, and hook plates extensions. 2,4,5,[7][8][9]11,12 The latter option is a modular addition to a standard VLP, which allows the decision to stabilize the fragment to be made at the end of the procedure.…”

“…1 Recently, a specific fracture fragment from this important bony buttress, the volar marginal fragment (VMF), has undergone significant scientific investigation. [2][3][4][5] The VMF, also referred to as the volar ulnar corner, volar marginal rim, and "critical corner," is a small peripheral fragment which forms the attachment point of the short radiolunate and radioulnar ligaments. 5 Loss of the VMF can result in volar subluxation of the carpus and distal radioulnar joint (DRUJ) instability.…”

Management of Lunate Facet Escape after Distal Radius Fracture Volar Plating: Surgical Technique

“…This makes fixation of the fragment with standard VLP difficult. LFE after volar plate and locking screws has been associated with less than 9 mm of palmar cortex, 11 or over 5 mm initial lunate subsidence. 12 Compressive articular fracture lines commonly propagate between facets and in the coronal plane.…”

“…If an intra-articular distal radius fracture with the involvement of the lunate facet (i.e., volar ulnar corner) is encountered primarily, we recommend primary dual plating with volar locking plate and dorsal bridge plate, especially if lunate facet fragment is small or unstable. 11 12 Dorsal bridge plate should not be removed until minimum 10 to 12 weeks, even with radiographic signs of healing. AP, skyline, and lateral views with radial inclination should be performed with fluoroscopy at end of case to confirm no intra-articular or dorsal screw perforation.…”