Abstract
Background and Purpose It is difficult to capture and safely support a small volar lunate facet (VLF) fragment
and obtain sufficient initial fixation. The challenge in treating VLF rim fractures
has resulted in various management options. The purpose of this study was to evaluate
the clinical and radiological outcomes of a consecutive series of VLF rim fractures
of the distal radius treated surgically and to report the Kondo–Imatani (K-I) classification
of these fractures, using computed tomography (CT) images and surgical technique,
which is termed the Plate buttress and Double tiered subchondral support (PD) technique.
Patients and Methods A retrospective review was conducted on 35 patients with VLF rim fractures that included
postoperative clinical evaluations, CT images, and radiographs.
Description of Technique The PD technique to stabilize the VLF fragment with an anatomical and low-profile
volar locking plate (VLP).
Results All fractures healed at the final follow-up; Mayo wrist performance score average
was 81.7 points (45–100), and the quick disabilities of the arm, shoulder, and hand
(quick-DASH) score average was 9.5 points (0–31.8), showing relatively good clinical
results.
Conclusion VLF rim fragments are not amenable to standard VLP fixation. Unstable fixation may
result in postoperative correction loss, aseptic necrosis, malunion, radiocarpal subluxation,
and wrist dysfunction. This report described the K-I classification for VLF rim fractures
of the distal radius and surgical technique, termed the PD technique, to stabilize
the VLF rim fragment with an anatomical and low-profile VLP.
Level of Evidence This is a Level IV, case series study.
Keywords
volar lunate facet - rim - distal radius fracture - volar locking plate
