Download PDF
J Hand Microsurg
DOI: 10.1055/s-0043-1761220
Surgical Technique

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

Alexander J. Adams 
1   Department of Orthopedic Surgery, Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania, United States
,
Asif M. Ilyas
1   Department of Orthopedic Surgery, Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania, United States
2   Rothman Opioid Foundation, Philadelphia, Pennsylvania, United States
› Author Affiliations Funding None.
› Further Information
    Permissions and Reprints

Abstract

Fractures involving the lunate facet of the distal radius (commonly called the volar ulnar corner or “critical corner”) are often difficult to recognize radiographically. “Lunate facet escape” refers to the displacement of this fragment after attempted distal radius fracture closed or open reduction methods. Lunate facet escape can have severe consequences including carpal collapse with pain, instability, and arthritis. Challenges to lunate facet fixation include irregular cortical contour that makes plate fixation difficult, as well as deforming forces by inserting structures. The goal of the management of a distal radius fracture with lunate facet involvement is first identification, then adequate stabilization until osseous healing occurs. However, subsequent lunate facet escape can pose a challenging clinical and surgical dilemma. Here we discuss our preferred approach to treat lunate facet escape after distal radius fracture volar locking plating failure.

Keywords

distal radius - volar locking plate - lunate facet escape - volar ulnar corner - critical corner


Publication History

Article published online:
13 March 2023

© 2023. Society of Indian Hand Surgery & Microsurgeons. All rights reserved.

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Harness NG, Jupiter JB, Orbay JL, Raskin KB, Fernandez DL. Loss of fixation of the volar lunate facet fragment in fractures of the distal part of the radius. J Bone Joint Surg Am 2004; 86 (09) 1900-1908
    CrossrefPubMedGoogle Scholar
  • 2 Saka N, Nimura A, Tsutsumi M, Nozaki T, Watanabe Y, Akita K. Anatomic study of fibrous structures attached to the volar ulnar corner of the radius: implications in the volar rim fracture. J Hand Surg Eur Vol 2021; 46 (06) 637-646
    CrossrefPubMedGoogle Scholar
  • 3 Miyamura S, Oka K, Lans J. et al. Cartilage and subchondral bone distributions of the distal radius: a 3-dimensional analysis using cadavers. Osteoarthritis Cartilage 2020; 28 (12) 1572-1580
    CrossrefPubMedGoogle Scholar
  • 4 Hozack BA, Tosti RJ. Fragment-specific fixation in distal radius fractures. Curr Rev Musculoskelet Med 2019; 12 (02) 190-197
    CrossrefPubMedGoogle Scholar
  • 5 Moore AM, Dennison DG. Distal radius fractures and the volar lunate facet fragment: Kirschner wire fixation in addition to volar-locked plating. Hand (N Y) 2014; 9 (02) 230-236
    CrossrefPubMedGoogle Scholar
  • 6 Biondi M, Keller M, Merenghi L, Gabl M, Lauri G. Hook plate for volar rim fractures of the distal radius: review of the first 23 cases and focus on dorsal radiocarpal dislocation. J Wrist Surg 2019; 8 (02) 93-99
    Article in Thieme ConnectPubMedGoogle Scholar
  • 7 Goorens CK, Geeurickx S, Wernaers P, Staelens B, Scheerlinck T, Goubau J. Midterm follow-up of treating volar marginal rim fractures with variable angle Lcp volar rim distal radius plates. J Hand Surg Asian Pac Vol 2017; 22 (02) 184-187
    CrossrefPubMedGoogle Scholar
  • 8 O'Shaughnessy MA, Shin AY, Kakar S. Stabilization of volar ulnar rim fractures of the distal radius: current techniques and review of the literature. J Wrist Surg 2016; 5 (02) 113-119
    Article in Thieme ConnectPubMedGoogle Scholar
  • 9 O'Shaughnessy MA, Shin AY, Kakar S. Volar marginal rim fracture fixation with volar fragment-specific hook plate fixation. J Hand Surg Am 2015; 40 (08) 1563-1570
    CrossrefPubMedGoogle Scholar
  • 10 Benis S, Vanhove W, Hollevoet N. Involvement of the palmar lunate facet in intra-articular distal radius fractures. Orthop Traumatol Surg Res 2020; 106 (02) 341-346
    CrossrefPubMedGoogle Scholar
  • 11 Benis S, Vanhove W, Hollevoet N. Volar plate fixation in intra-articular distal radius fractures with a volar lunate facet fragment. Hand Surg Rehabil 2020; 39 (04) 270-274
    CrossrefPubMedGoogle Scholar
  • 12 Beck JD, Harness NG, Spencer HT. Volar plate fixation failure for volar shearing distal radius fractures with small lunate facet fragments. J Hand Surg Am 2014; 39 (04) 670-678
    CrossrefPubMedGoogle Scholar
  • 13 Ilyas AM. Surgical approaches to the distal radius. Hand (N Y) 2011; 6 (01) 8-17
    CrossrefPubMedGoogle Scholar
  • 14 Majima M, Horii E, Matsuki H, Hirata H, Genda E. Load transmission through the wrist in the extended position. J Hand Surg Am 2008; 33 (02) 182-188
    CrossrefPubMedGoogle Scholar
  • 15 Genda E, Horii E. Theoretical stress analysis in wrist joint–neutral position and functional position. J Hand Surg [Br] 2000; 25 (03) 292-295
    CrossrefPubMedGoogle Scholar
  • 16 Tannan SC, Pappou IP, Gwathmey FW, Freilich AM, Chhabra AB. The extended flexor carpi radialis approach for concurrent carpal tunnel release and volar plate osteosynthesis for distal radius fracture. J Hand Surg Am 2015; 40 (10) 2026-2031.e1
    CrossrefPubMedGoogle Scholar
  • 17 Tordjman D, Hinds RM, Ayalon O, Yang SS, Capo JT. Volar-ulnar approach for fixation of the volar lunate facet fragment in distal radius fractures: a technical tip. J Hand Surg Am 2016; 41 (12) e491-e500
    CrossrefPubMedGoogle Scholar
  • 18 Guerrero EM, Lauder A, Federer AE, Glisson R, Richard MJ, Ruch DS. Metacarpal position and lunate facet screw fixation in dorsal wrist-spanning bridge plates for intra-articular distal radial fracture: a biomechanical analysis. J Bone Joint Surg Am 2020; 102 (05) 397-403
    CrossrefPubMedGoogle Scholar
  • 19 Azad A, Choi JT, Fisch R, Gipsman A, Nicholson LT, Ghiassi A. Wrist-spanning fixation of radiocarpal dislocation: a cadaveric assessment of ulnar translation. Hand (N Y) 2021; 16 (04) 482-490
    CrossrefPubMedGoogle Scholar
  • 20 Streubel PN, Cohen MS. Isolated partial intra-articular volar ulnar fractures of the distal radius: the tetrahedron variant. J Hand Surg Am 2019; 44 (08) 699.e1-699.e10
    CrossrefPubMedGoogle Scholar
  • 21 Gavaskar AS, Parthasarathy S, Balamurugan J, Raj RV, Anurag R, Gopinath D. Volar hook plate stabilization of volar marginal fragments in intra-articular distal radius fractures. Injury 2021; 52 (01) 85-89
    CrossrefPubMedGoogle Scholar
  • 22 Fogel N, Shapiro LM, Roe A, Denduluri S, Richard MJ, Kamal RN. Outcomes of supplementary spring wire fixation with volar plating for volar lunate facet fragments in distal radius fractures. Hand (NY) 2020; DOI: 10.1177/1558944720976404.
    CrossrefPubMedGoogle Scholar
  • 23 Konrath GA, Bahler S. Open reduction and internal fixation of unstable distal radius fractures: results using the trimed fixation system. J Orthop Trauma 2002; 16 (08) 578-585
    CrossrefPubMedGoogle Scholar
  • 24 Helmerhorst GT, Kloen P. Orthogonal plating of intra-articular distal radius fractures with an associated radial column fracture via a single volar approach. Injury 2012; 43 (08) 1307-1312
    CrossrefPubMedGoogle Scholar
  • 25 Medlock G, Smith M, Johnstone AJ. Combined volar and dorsal approach for fixation of comminuted intra-articular distal radial fractures. J Wrist Surg 2018; 7 (03) 219-226
    Article in Thieme ConnectPubMedGoogle Scholar
  • 26 Özkan S, Mudgal CS, Jupiter JB, Bloemers FW, Chen NC. Scapholunate diastasis in distal radius fractures: fracture pattern analysis on CT scans. J Wrist Surg 2020; 9 (04) 338-344
    Article in Thieme ConnectPubMedGoogle Scholar