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Distal Radius Volar Locking Plates: A Comparison of Volar Lunate Facet Support
Roongsak Limthongthang, MD1; Abdo Bachoura, MD2; Sidney M. Jacoby, MD2; A. Lee Osterman, MD2
1Faculty of Medicine Siriraj Hospital, Mahidol University, Thailand; 2The Philadelphia Hand Center, Thomas Jefferson University. Philadelphia, PA

Introduction: The stability of a volar lunate fragment reduction and fixation is crucial in comminuted intraarticular fractures of the distal radius. The volar extension of the lunate articular surface may prevent conventional distal radius volar locking plate (VLP) from supporting it effectively. We conducted a 3-dimensional anatomical study, aiming to provide the guideline of the volar lunate facet fragment size that could be effectively fixed by various VLP designs.
Methods: Ten fresh-frozen upper extremity specimens were dissected and the distal part of the radius severed. Five VLPs were fixed in its proper anatomic fit, as close to the watershed line as possible. Fluoroscopy was used to adjust the plate positions, and classified according to Soong's grading system. A three-dimension scanner was used to create computer models. The ability of volar lunate facet support was measured using a combination of 6-sagittal-plane cuts through the most volar prominence of the lunate facet. One-way ANOVA was used to analyze the distance from the Plate-edge to Volar-rim of the Distal radius (PVD) and the Plate-edge to Volar-rim of the Lunate articular Facet (PVLF) for each VLP design. A two tailed p-value less than 0.05 was considered statistically significant.
Results: The average PVD was 2.880.99 mm (min 1.15; max 5.23 mm) and PVLF was 5.620.9 mm (min 3.79; max 8.25 mm) for all VLP design. Significant differences in both parameters were noted for various designs.
Discussion and Conclusion: Given the proper position of the VLP fixation that just proximal to the watershed line, the ability of each design in supporting the volar extension of the lunate facet is difference. We merged the sagittal cuts of the models just over the prominence part of the lunate facet, in order to eliminate the overlapping of radial bony column and plate, which generally difficult to distinguish by lateral view x-ray. The described measurement parameters may help guide in better preoperative planning to measure the size of the volar lunate fragment, which could be securely fixed by conventional volar locking plate.


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