Elsevier

Injury

Volume 43, Issue 7, July 2012, Pages 1204-1208
Injury

The extended flexor carpi radialis approach for partially healed malaligned fractures of the distal radius

https://doi.org/10.1016/j.injury.2012.04.002Get rights and content

Abstract

Purpose

The aim of the study is to evaluate the safety and utility of the extended flexor carpi radialis (FCR) exposure and volar locking plate fixation for partially healed malaligned fractures of distal radius.

Materials and methods

Thirty-five patients with a partially healed malaligned fracture of the distal radius had realignment of the fracture using an extended FCR approach (release of the insertion of the brachioradialis and dorsal periosteum) and volar locked plate and screw fixation.

Results

Retrospective review an average of 20 months after the index operation patients identified an average wrist extension of 68°, flexion of 64°, pronation of 84° and supination of 85°. Radial inclination, volar tilt and ulnar variance significantly improved compared to preoperative radiographs. All fractures healed, and there were no infections, implant loosening or breakage or tendon ruptures.

Conclusions

This study demonstrated that the extended FCR approach is safe and effective as a treatment method for nascent malunions of the distal radius.

Section snippets

Participants

From 2001 to 2006, two surgeons treated 50 patients with dorsally displaced partially healed malaligned fractures of the distal radius using an extended FCR exposure and volar plate and screw fixation at two different centres (Fig. 1). For the purposes of this review, malaligment was defined as 15° or greater dorsal angulation of the articular surface of the distal radius on a lateral radiograph or greater than 2 mm of ulnar positive variance on the posteroanterior radiograph.

The inclusion

Results

The patients were evaluated an average of 20 months (range, 14–54 months) after the index operative procedure. The patients achieved a final average wrist extension of 68° (range, 50–80°), wrist flexion of 64° (range, 30–90°), pronation of 84° (range, 70–100°) and supination of 85° (range, 79–90°).

Preoperative radiographic measurements included an average dorsal tilt of the articular surface of the distal radius of 15° (range, 2–35° dorsal tilt), average radial inclination of 28° (range, 8–35°

Discussion

This study documented good results with few complications using the extended FCR exposure for release of soft tissues and fracture callus to facilitate mobilisation of partially healed malaligned fractures of the distal radius. Maintaining the ulnar soft-tissue attachments to the radial shaft seems to preserve adequate blood supply, and nonunion, infection and osteonecrosis have not been encountered to date.4The patients in this series had an average correction of 22° of palmar tilt and 3.5 mm

Funding

There was no direct financial support for this study.

Conflict of interest

David Ring is a consultant for Wright Medical, Biomet and Skeletal Dynamics; has research contracts with Biomet and Skeletal Dynamics; receives royalties from Wright Medical; and has contracts for future royalties with Biomet and Skeletal Dynamics.

Jorge Orbay owns Skeletal Dynamics. He created the hand innovations plate used in these patients, but no longer has financial ties to the plate.

References (10)

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    Citation Excerpt :

    Since 2000, distal radius fracture fixation by volar locking plate has become the gold standard [1,2]. Three approaches have been described: traditional, extended [3], and minimally invasive [4]. The traditional flexor carpi radialis (FCR) approach (Fig. 1A), described for anterior displacement [5], is the distal part of Henry's approach [6].

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