What Else Can We Use? Alternative Fixation Methods of the Volar Lunate Facet Fracture of the Distal Radius

Abstract

Purpose: The anatomy of the "critical corner" in volar lunate facet fractures makes achieving fixation difficult, and standard precontoured volar locking plates may be limited in certain fracture patterns. The purpose of this review was to identify various fixation techniques for the volar lunate facet and review the outcomes data associated with each fixation method.

Methods: A review of the literature was performed by first screening the PubMed database for relevant articles using key terms: "volar lunate facet," "critical corner," and "distal radius fractures." Two reviewers independently assessed all 87 articles for relevance. Articles were included if both reviewers agreed on their inclusion and if they described an alternative fixation method for treating volar lunate facet fractures. The reviewers then extracted as much data as possible regarding the fixation methods, including technique, sample size, follow-up period, and various outcomes such as range of motion, grip strength, return to work, and rates of union.

Results: Of the 28 articles that were included, the fixation methods reviewed were categorized into direct Kirschner wire fixation, compression fixation-"spring wire fixation," tension fixation-"wire-loop fixation," and containment fixation with the use of a buttress pin in various configurations. These alternative fixation methods had high rates of union, few complications, and good to excellent clinical outcomes.

Conclusions: The limitations of using a single volar locking plate for volar lunate facet fractures have led to the development of novel fixation techniques. Although these alternative fixation methods have demonstrated promising outcomes, the existing studies have small sample sizes.

Clinical relevance: Distal radius fractures involving the volar lunate facet present a challenge in operative fixation due to the various anatomical features described. Each unique fracture pattern must be thoroughly evaluated to determine the most appropriate fixation method.

Keywords: Alternative fixation; Critical corner; Distal radius fracture; Volar locking plate; Volar lunate facet.

Figure 1

Direct open reduction with K-wire fixation in a 25-year-old man, as per Halbrecht and Stuchin in 1988. This article is distributed under the terms of the Creative Commons Attribution-Non Commercial 4.0 International License, which permits noncommercial use and redistribution provided that the original author and source are credited.

Figure 2

Surgical technique for spring wire fixation as described by Moore and Dennison. One or two K-wires, depending on fragment size, are driven through into the dorsal cortex and bent over the volar cortex. A volar locking plate is then applied over the K-wires. Adapted with permission obtained from SAGE Publications.

Figure 3

Operative fixation of the volar lunate facet in distal radius fracture using the spring wire fixation technique in a 38-year-old male. Adapted with permission from Moore and Dennison. Permission was obtained from SAGE Publications.

Figure 4

Operative fixation of the volar lunate facet in distal radius fracture using the wire-loop fixation technique in a 23-year-old male. Adapted with permission from Chin and Jupiter JB. Permission was obtained from Elsevier.