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2014 ; 9
(2
): 230-6
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Distal radius fractures and the volar lunate facet fragment: Kirschner wire
fixation in addition to volar-locked plating
#MMPMID24839427
Moore AM
; Dennison DG
Hand (N Y)
2014[Jun]; 9
(2
): 230-6
PMID24839427
show ga
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 (2006-2011) 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° supination. 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 volar-locked 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.