gms | German Medical Science

14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

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Displaced dorsal lunate facet fracture treated with a volar locking plate. Is it advantageous to capture the fragment with a full length locking screw?

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  • presenting/speaker Jesse Jupiter - Massachusetts General Hospital, Harvard Medical School, Boston, United States

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-282

doi: 10.3205/19ifssh1359, urn:nbn:de:0183-19ifssh13595

Published: February 6, 2020

© 2020 Jupiter.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objectives/Interrogation: Stability of fixation of an extraarticular distal radius fracture using a volar locking plate can be achieved with screw lengths 75% of the height of the bone avoiding dorsal tendon problems. Is this valid with dorsal lunate facet fragment displacement? This study will demonstrate the safety and efficacy of capturing the displaced fracture with a full length screw using variable angle implants

Methods: From the ICUC data base of 203 distal radius fractures, we identified 10 cases of intraarticular fractures featuring a displaced dorsal lunate facet which was stabilized with a full length locking screw through a variable angle volar plate. Eight patients were female and 2 male with an average age of 66.5 yrs (range 50-85). All fractures were analyzed by both preoperative and postoperative CT specifically documented the placement of the volar ulnar screw, the alignment of the sigmoid notch, and the position of the volar plate. Patient follow up emphasized forearm function and stability of the distal radioulnar joint.

Results and Conclusions: The average follow up was 104.6 weeks (range 26-343). The postoperative CT scans demonstrated stable reduction and fixation of the dorsal lunate facet in all but one case. The sigmoid notch reduction was within 1 mm step off in all but one which had 1 mm impaction and 1.5 mm gap. The position of the plate was Soong 0 in 7 and Soong 1 in 3. There were no dorsal or volar tendon problems noted. The forearm rotation was full in all 10 patients

The angular stable plate construction allows the fixation of a dorsal lunate facet fracture as well as the sigmoid notch while maintaining the plate in a safe position and without extensor tendon irritation.