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 (2006-2011) 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.

Keywords: Distal radius; Kirschner wire; Locked plating; Lunate.

Fig. 1

a Sagittal computed tomography and b 3-D reconstruction images of the volar marginal fragment (arrows) with carpal subluxation. c, d 3D reconstructive images demonstrate volar marginal fragment that can involve the distal radial ulnar joint (DRUJ)

Fig. 2

Surgical technique of spring wire fixation. (1) Lateral view of distal radius demonstrates adequate reduction of the fracture fragments. (2) Using small 0.035″ Kirschner wire, the volar marginal fragment is captured, and wire is advanced to far cortex. (3) The K-wire is then bent to match the curve of the volar rim and cut long enough to be secured under volar plate. (4) The rest of the distal radius fragments are secured with standard volar plating technique

Fig. 3

a Anteroposterior and b lateral preoperative films of a 38-year-old man with an intra-articular, unstable distal radius fracture with a volar marginal fragment (arrow). Postoperative x-rays, c anteroposterior and d lateral, after spring wire fixation of the volar marginal fragment and volar-locked plating demonstrate stable fixation of this critical fracture fragment