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Use of a Low-Profile, Dorsally-Integrated Compression Screw Device to Stabilize Displaced Dorsal Lunate Facet Fragments in Intra-Articular Distal Radius Fractures
Jeremy Miles, MD; Suhail Mithani, MD; Marc Richard, MD; David S Ruch, MD
Duke University, Durham, NC
Introduction: Traditional dorsal lunate facet fixation in intra-articular distal radius fractures relies on either bicortical screws from volar locked plating or dorsal plating, both of which have well documented complications. We hypothesized that a new dorsal compression screw device integrated into a volar locked plate will stabilize displaced dorsal lunate facet fragments with acceptable clinical outcomes and without radiographic displacement or complications.
Methods: An IRB-approved retrospective institutional database review was performed to identify patients who had a closed, intra-articular distal radius fracture with a displaced dorsal lunate facet fragment during a 28-month period. All patients were at least 18 years of age, had no concomitant ipsilateral upper extremity injury, and had clinical and radiographic outcome of at least 6 months or until the time of union.
Results: Eleven patients met inclusion criteria with mean age of 53 years. Mean follow-up was one year (range 6-22 months). All patients went on to clinical and radiographic union. Clinically, patients regained 88% and 82% of wrist flexion and extension, respectively, with 98% and 99% recovery of pronation and supination, respectively, compared to the contralateral extremity. Radiographically, mean radial height was 11.8 mm (range 8.9 to 15.1 mm), ulnar variance averaged -0.1mm (-4.7 to 3.7 mm), volar tilt averaged 3.6 degrees (-3 to 13.5 degrees) and there was no articular step-off or gap on final radiographs. There was no dorsal lunate fragment migration, revision surgeries, nonunions, or clinical evidence of extensor tenosynovitis or irritation at final follow-up.
Summary Points: - The dorsal lunate facet was effectively stabilized without radiographic or clinical evidence of complication using a dorsal compression screw that integrates into a volar locked plate in our cohort of patients.
- Controlled studies comparing this mode of dorsal lunate facet fixation are needed to determine superiority to alternative fixation techniques.
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