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

• Published in: Journal of hand and microsurgery Vol. 16; no. 1; p. 100018
• Main Authors: Adams, Alexander J., Ilyas, Asif M.
• Format: Journal Article
• Language: English
• Published: A-12, 2nd Floor, Sector 2, Noida-201301 UP, India Elsevier B.V 01.03.2024; Thieme Medical and Scientific Publishers Pvt. Ltd
• Subjects: critical corner; distal radius; lunate facet escape; Surgical Technique; volar locking plate; volar ulnar corner; distal radius; lunate facet escape; critical corner; volar locking plate; volar ulnar corner
• ISSN: 0974-3227; 0974-6897
• DOI: 10.1055/s-0043-1761220

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.