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.
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http://dx.doi.org/10.1055/s-0043-1761220 | DOI Listing |
J Hand Surg Eur Vol
January 2025
Department of Orthopedics, E-Da Hospital, I-Shou University/School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan.
Treatment of distal radial fractures that include small anterior rim fragments can be difficult. We retrospectively reviewed 19 patients in whom an anterior rim plate with locking screws was used. After a median follow-up of 18 months (range 6-32; interquartile range (IQR) 14, 26), the median wrist flexion and extension arc was 70° (range 50-80; IQR 60, 70), the median grip strength was 80% of the contralateral side (range 52-104; IQR 77, 88), the median visual analogue scale score for pain was 0 (range 0-5; IQR 0, 1), the median disabilities of the arm, shoulder and hand score was 2 (range 0-59; IQR 0, 11) and the median modified Mayo wrist score was 80 (range 35-100; IQR 75, 85).
View Article and Find Full Text PDFJ Am Acad Orthop Surg
December 2024
From the Zucker School of Medicine at Hofstra/Northwell, New York Hand and Wrist Center of Lenox Hill, New York.
Surgical fixation of unstable distal radius fractures greatly depends on the characteristics of the fracture pattern. Intra-articular fractures of the distal radius often involve several key fragments that require adequate reduction and fixation. The volar lunate facet is just one of those fragments, making up the critical corner of the distal radius articular surface and serving as the keystone to both the radiocarpal and distal radioulnar joints.
View Article and Find Full Text PDFRev Bras Ortop (Sao Paulo)
December 2024
Departamento de Ortopedia, Traumatologia e Cirurgia da Mão, Faculdade de Medicina, Ankara University, Altındağ, Ankara, Turquia.
To assess the efficacy of distal radius volar plates in cases involving dorsal fragments at the Ulnar Corner (UC) and Lister Tubercle (LT). A retrospective study that included patients with distal radius fractures (DRFs) featuring UC and LT dorsal fragments treated with volar plates. The exclusion criteria comprised lunate facet fractures, UC fragment ratio below 25%, and patients treated with dorsal plates.
View Article and Find Full Text PDFJ Hand Surg Am
November 2024
Department of Orthopaedic Surgery, Stanford University Medical Center, Redwood City, CA. Electronic address:
Purpose: Although studies have demonstrated that locked screws with a length of 75% of the radius width are sufficient for the treatment of extra-articular fractures of the distal radius, the application of this principle to intra-articular fractures is less well-understood. This study aimed to evaluate the biomechanical properties of different types of volar plate fixation constructs for the treatment of distal radius fractures in the presence of a dorsal critical corner fragment.
Methods: A dorsal critical corner fracture was created in 18 synthetic distal radius models.
Hand (N Y)
November 2024
Mayo Clinic, Rochester, MN, USA.
Background: This study aimed to evaluate and compare the outcomes of proximal row carpectomy (PRC) with interposition arthroplasty using dorsal wrist capsule interposition, lateral meniscus allograft, or dermal allograft in patients with lunate facet/capitate degeneration.
Methods: Patients who underwent PRC with interposition arthroplasty between 2010 and 2022 at a single institution were identified. Preoperative and postoperative visual analog scale (VAS) pain, functional outcomes, and complications were recorded.
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