Articular Fragment Escape and Carpal Subluxation Following Distal Radius Fracture Fixation

Surgical fixation of distal radius fractures is among the more common procedures performed by hand surgeons. The approach to surgical management is based on a variety of factors including injury mechanism, fracture pattern, patient characteristics, bone quality, soft tissue injury, and surgeon preference. For the majority of fracture types, volar locking plate fixation has become the most commonly used method of fracture fixation. Although uncommon, complications can arise following this form of treatment, one of which is escape of an articular fragment with resultant carpal instability. More often seen in conjunction with poorly reduced or captured displaced volar lunate facet fragments, fixation failure and carpal instability can occur with other fracture patterns that have garnered less attention, particularly those involving the radial column or dorsal lunate facet. Thorough preoperative planning to recognize fracture patterns that lead to this complication is paramount. Proper selection of implants used to secure the fracture and the choice as well as duration of postoperative immobilization is critical to minimizing this complication. We aim to (1) describe the relevant anatomy involved with this complication, (2) organize and classify the various distal radius articular fragment escape patterns that can occur following fracture fixation, and (3) discuss strategies that can help prevent this complication.