Assessment and Fixation Strategies for the Unstable Volar Lunate Facet

Surgical fixation of unstable distal radius fractures greatly depends on the characteristics of the fracture pattern. Intra-articular fractures of the distal radius often involve several key fragments that require adequate reduction and fixation. The volar lunate facet is just one of those fragments, making up the critical corner of the distal radius articular surface and serving as the keystone to both the radiocarpal and distal radioulnar joints. Satisfactory reduction and stabilization of this fragment can be very challenging, and failure of this can lead to volar subluxation of the carpus, distal radioulnar incongruence with resultant instability, and ultimately poor patient outcomes. This review aims to highlight the relevant anatomy and proper imaging crucial to the understanding and evaluation of distal radius fractures involving an unstable volar lunate facet fragment. In addition, we highlight steps in obtaining adequate exposure of the critical corner and numerous fixation strategies that can assist to optimally stabilize it.