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J Wrist Surg 2019; 08(02): 118-123
DOI: 10.1055/s-0038-1673407
Scientific Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Dorsal Lunate Facet Fracture Reduction Using a Bone Reduction Forceps

Jonathan Lans
1   Department of Orthopedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
,
Josefina Alvarez
2   Department of Traumatology, British Hospital, Montevideo, Uruguay
,
Amir R. Kachooei
3   Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
,
Sezai Ozkan
1   Department of Orthopedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
,
Jesse B. Jupiter
1   Department of Orthopedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
› Author Affiliations
Further Information

Publication History

21 February 2018

27 August 2018

Publication Date:
03 October 2018 (online)

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Abstract

Background The dorsal lunate facet fragment represents part of a complex articular injury of the distal radius and is challenging to reduce through a standard volar approach. We propose reduction through a standard volar approach and intraoperative dorsal lunate facet reduction using a bone forceps. To evaluate the postoperative reduction, we used computed tomography (CT) scan.

Methods We retrospectively included 60 patients with a median follow-up of 44 weeks. Fracture reduction was evaluated using pre- and direct postoperative CT scans of the wrist, measuring the articular gap and step of the sigmoid notch. The range of motion was evaluated clinically by the treating physician. Bivariate analysis was performed to compare pre- and postoperative radiographic measurements and to compare wrist range of motion.

Results When comparing the injured with the uninjured wrist, there was a significant difference in flexion, extension, pronation, and supination. In 87% of the patients, there was complete radiographic reduction of the fracture.

Conclusion This study shows that dorsal ulnar lunate facet fracture fragments in distal radius fractures can be reduced through a standard volar approach with the help of an intraoperative bone reduction forceps. Using wrist CT, we showed that 87% of the patients with a dorsal ulnar lunate facet fragment had a postoperative articular step or gap of <1 mm.

Level of Evidence: This is a level IV, therapeutic study.

Keywords

radiographic evaluation - radius fracture - volar plate fixation

Note

This work was performed at the Department of Orthopedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States, in collaboration with the Department of Traumatology, British Hospital, Montevideo, Uruguay.


 

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