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J Wrist Surg 2022; 11(06): 484-492
DOI: 10.1055/s-0041-1742228
Scientific Article

Volar Lunate Facet Fractures of the Distal Radius: Fracture Mapping Using 3D CT Scans

Jock Clarnette 
1   Department of Orthopaedic and Trauma Surgery, Flinders University and Flinders Medical Centre, Adelaide, Australia
2   Department of Orthopaedics and Trauma, Royal Adelaide Hospital and The University of Adelaide, Adelaide, Australia
,
April De Silva
2   Department of Orthopaedics and Trauma, Royal Adelaide Hospital and The University of Adelaide, Adelaide, Australia
,
Nathan Eardley-Harris
1   Department of Orthopaedic and Trauma Surgery, Flinders University and Flinders Medical Centre, Adelaide, Australia
,
Simon MacLean
3   Department of Orthopaedic Surgery, Tauranga Hospital, Tauranga, Bay of Plenty, New Zealand
,
Gregory I. Bain
1   Department of Orthopaedic and Trauma Surgery, Flinders University and Flinders Medical Centre, Adelaide, Australia
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Abstract

Background Fractures of the distal radius involving the lunate facet at the volar articular surface are unstable injuries and are usually managed operatively. Management of these fractures is challenging as our understanding of the exact fracture characteristics and associated injuries to the carpus is poor.

Purpose This study aims to define the anatomy and associated injuries of lunate facet fractures using three-dimensional computed tomography (CT) scans and fracture mapping techniques.

Methods A consecutive series of CT wrists was analyzed to identify intra-articular fractures involving the lunate facet at the volar distal radius. Fractures were mapped onto standardized templates of the distal radius using previously described fracture mapping techniques. We also identified instabilities of the carpus including volar carpal translation, ulnar translocation, scapholunate diastasis, and distal radioulnar joint (DRUJ) instability.

Results We present 23 lunate facet fractures of the distal radius. The lunate facet fragment displaces in a volar and proximal direction and the lunate always articulates with the displaced fragment. The smaller fragments displace a greater amount, in a volar direction, with pronation. The fracture tends to occur between the origin of the short and long radiolunate ligaments.

Conclusion Lunate facet fractures are frequently comprised of osteoligamentous units of the distal radius involving the short and long radiolunate ligaments and the radioscaphocapitate ligament. Assessment and management of volar carpal subluxation, scapholunate instability, ulnar translocation, and DRUJ instability should be considered.

Clinical relevance Our mapping of these fractures contributes to our understanding of the anatomy and associated instabilities and will aid in surgical planning and decision making.

Keywords

lunate facet fracture - distal radius - fracture mapping - classification - carpal instability

Ethical Approval

The Southern Adelaide Clinical Human Research Ethics Committee (SAC HREC EC00188) have reviewed and provided ethical approval for this application which appears to meet the requirements of the National Statement on Ethical Conduct in Human Research. Application Number is OFR # 14.17 - HREC/17/SAC/31.




Publication History

Received: 10 May 2021

Accepted: 09 December 2021

Article published online:
20 January 2022

© 2022. Thieme. All rights reserved.

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