Surgical techniqueVolar Approach to Distal Radius Fractures
Section snippets
Indications and Contraindications
The indications for use of the volar approach to the distal radius have expanded with the proliferation of volar fixed-angle plates. The classic indications for volar plating include the volar articular shear fracture—the eponymous “volar Barton” fracture, and the volarly displaced extra-articular fracture or “Smith fracture.” However, with the availability of locking screw technology, fractures that classically have been treated with a dorsal approach or with external fixation now can be
Surgical Anatomy
The volar approach of Henry uses the interval between the FCR and the radial artery to gain access to the distal radius. Structures most directly at risk during the dissection include the superficial palmar cutaneous branch of the median nerve and the radial artery. If the dissection stays maintained to the radial side of the FCR, the palmar branch of the median nerve is not likely to be injured. Therefore, the nerve does not need to be identified formally during the approach. If a carpal
Surgical Technique
An incision is made overlaying the FCR tendon (Fig. 1). The interval of the dissection will proceed between the FCR and the radial artery in order to avoid injury to the palmar cutaneous branch of the median nerve, which lies just ulnar to the FCR (Fig. 2). This nerve does not need to be identified if the dissection is maintained to the radial side of the FCR. The FCR tendon sheath is incised sharply in a longitudinal direction, and the FCR can be retracted ulnarly. The radial artery is
Postoperative Care and Rehabilitation
For more stable fractures, the wrist is placed into a prefabricated wrist splint. If the fracture has an unstable DRUJ or a high-energy mechanism, a sugar tongue splint is placed with the forearm maintained in approximately 60° of supination. The patient can initiate gentle finger range-of-motion exercises in the splint during the period leading up to the first postoperative visit. The sutures are removed 10–14 days after surgery. A customized, well-padded orthoplastic wrist splint is fashioned
Clinical Case
The patient is a 45-year-old right-handed registered nurse who sustained a fall onto an outstretched hand. She was seen and evaluated in our emergency room. X-rays demonstrated an intra-articular distal radius fracture (Fig. 11A). After administration of a hematoma block, a reduction maneuver was performed, and the patient was placed into a well-molded sugar tongue splint. She followed up in the clinic, and after discussing all treatment options, she elected to proceed with surgical management
Pearls and Pitfalls
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The key to a successful reduction is rebuilding the fractured radius, beginning with the volar lunate facet and then moving dorsally and radially.
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Releasing the brachioradialis aids in the restoration of radial inclination (Fig. 4).
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Plate positioning should always be gauged fluoroscopically while applying a traction reduction maneuver, to avoid underestimating the true radial length (Fig. 8).
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The 20° lateral tilt view is critical for ensuring that the distal screws or pegs are extra-articular and
Complications
Complications of volar plating of the distal radius include loss of fixation, injury to the palmar cutaneous branch of the median nerve, postoperative carpal tunnel syndrome, extensor tendon rupture, and postoperative loss of motion. Loss of fixation can occur catastrophically, particularly if care is not taken to reduce and capture the volar lunate facet fragment with the plate's more ulnar locking screws. If the mechanism of injury involves one of high energy, or if symptoms of carpal tunnel
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Enhanced Approaches to the Treatment of Distal Radius Fractures
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2023, Journal of Hand SurgeryPredictors of Acute Carpal Tunnel Syndrome Following ORIF of Distal Radius Fractures: A Matched Case–Control Study
2019, Journal of Hand Surgery Global OnlineCitation Excerpt :Odumala et al11 found that patients receiving prophylactic CTR were twice as likely as patients who did not undergo release to develop “median nerve dysfunction as an acute complication.” Others advocated prophylactic release only in the presence of described risk factors for developing acute CTS, such as highly displaced or comminuted fracture fragments before reduction and high-energy injury mechanisms.5,13 We confined our investigation to factors predicting the development of acute CTS within the 3 weeks after DRFx-ORIF.
The role of brachioradialis release during AO type C distal radius fracture fixation
2017, Orthopaedics and Traumatology: Surgery and Research
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