Dorsal Subluxation of The Proximal Carpal Row with the Use of a Bridge Plate

Abstract

Background Spanning bridge plates were first popularized for fixation of complex distal radius fractures. However, indications for their use have expanded including the surgical treatment algorithm for treating conditions such as Kienböck's disease. Traditionally, initial surgical treatment of Lichtman Stages II to III Kienböck's disease included lunate decompression, unloading, and revascularization procedures. The addition of a dorsal spanning bridge plate further facilitates lunate offloading and may improve bone revascularization.

Case Description We report a complication of proximal carpal row dorsal subluxation secondary to dorsal spanning plate fixation in a patient with Stage IIIb Kienböck's disease. The patient had undergone wrist arthroscopy, lunate forage, radius core decompression, and spanning plate fixation. At 6 weeks after surgery, radiographic imaging demonstrated dorsal subluxation of the proximal carpal row that was corrected upon bridge plate removal. Serial radiographs during follow-up showed no further carpal subluxation without Kienböck's disease progression at 12 months postremoval of hardware. Patient remains pain free and has returned to elite level sport.

Literature Review To our knowledge no previous cases of proximal carpal row subluxation with the use of dorsal bridge plate has been reported in the literature.

Clinical Relevance Proximal row carpal subluxation can occur with dorsal bridge plate fixation.

Keywords

carpal subluxation - bridge plating - Kienböck's disease - wrist pain

Publication History

Received: 28 March 2022

Accepted: 01 August 2022

Article published online:
09 November 2022

• References

• 1 Keith PP, Nuttall D, Trail I. Long-term outcome of nonsurgically managed Kienböck's disease. J Hand Surg Am 2004; 29 (01) 63-67
• 2 Schuind F, Eslami S, Ledoux P. Kienbock's disease. J Bone Joint Surg Br 2008; 90 (02) 133-139
• 3 DeGeorge Jr BR, Chawla SS, Lewallen L, Kakar S. Functional and radiographic disease progression in nonoperatively managed Kienböck disease. Plast Reconstr Surg 2021; 147 (05) 1117-1123
• 4 Tatebe M, Horii E, Majima M, Koh S, Nakamura R, Hirata H. Radial osteotomy for Kienböck's disease with displaced fracture of the lunate. J Hand Surg Am 2007; 32 (09) 1343-1347
• 5 Kakar S, Shin AY. Vascularized bone grafting from the dorsal distal radius for Kienböck's disease: technique, indications and review of the literature. Chir Main 2010; 29 (Suppl. 01) S104-S111
• 6 De Carli P, Zaidenberg EE, Alfie V, Donndorff A, Boretto JG, Gallucci GL. Radius core decompression for Kienböck disease stage IIIA: outcomes at 13 years follow-up. J Hand Surg Am 2017; 42 (09) 752.e1-752.e6
• 7 Illarramendi AA, Schulz C, De Carli P. The surgical treatment of Kienböck's disease by radius and ulna metaphyseal core decompression. J Hand Surg Am 2001; 26 (02) 252-260
• 8 Yajima H, Ono H, Tamai S. Temporary internal fixation of the scaphotrapezio-trapezoidal joint for the treatment of Kienböck's disease: a preliminary study. J Hand Surg Am 1998; 23 (03) 402-410
• 9 Wigton MD, Nazir OF, Graves BR, Apel PJ, Li Z. Dorsal distraction plating and lunate decortication for stage III Kienböck disease: a novel technique. Tech Hand Up Extrem Surg 2017; 21 (01) 13-17
• 10 Nicholson LT, Pidgeon TS, Lauder A, Rellan I, Richard MJ, Ruch DS. Lunate revascularization with temporary internal radiocarpal spanning fixation for Kienböck disease. Hand (N Y) 2021;•••:15589447211006858
• 11 Fares AB, Childs BR, Polmear MM, Clark DM, Nesti LJ, Dunn JC. Dorsal bridge plate for distal radius fractures: a systematic review. J Hand Surg Am 2021; 46 (07) 627.e1-627.e8