Arthroscopic Management of Volar Lunate Facet Fractures of the Distal Radius

ABSTRACT The clinical outcome of an intraarticular distal radiusfracture is generally thought to be associated with thefollowing factors: amount of radial deformity, jointcongruity, and associated soft-tissue injuries.The proposed technique to manage this fracturepattern that involves a displaced volar lunate facetfragment uses wrist arthroscopy and pinning. Distrac-tion of the fracture before arthroscopy is accomplishedeither by external fixation or by the arthroscopy tower.A freer elevator is introduced dorsally to disimpact thefragments, and next, a nerve hook is used to reduce thevolar lunate facet, which is subsequently pinned to theradial styloid. The remaining fragments are reducedwith interfragmentary pin fixation, and this anatomicalarticular construct is fixed to the radial metaphysis.The advantages of this technique are: (a) accurateassessment of articular congruency by direct visual-ization, (b) identification and repair of associatedlesions, and (c) minimal soft tissue disruption. Potentialdisadvantages of external fixation supplemented byinterfragmentary pins may be that it does not providefor rigid stable fixation, and therefore, does not allowfor early motion compared to open reduction andinternal fixation. Furthermore, it is technically challeng-ing, and is therefore suggested as an alternative for theaforementioned fracture pattern.Keywords: distal radius, fractures, arthroscopy, pins,volar lunate facets