The extended flexor carpi radialis approach for partially healed malaligned fractures 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.
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