Session IX - Upper Extremity

*The Treatment of Unstable Distal Radius Fractures with the DVR Plate and the Extended Flexor Carpi Radialis Approach

Jorge L. Orbay, MD; Alejandro Badia, MD; Igor Indriago, MD; Roger Khouri, MD; Eduardo Gonzalez, MD, Miami Hand Center, Miami, FL (all authors ­ e-Hand Innovations)

Purpose: We present our clinical experience with a new internal fixation method for the general treatment of the unstable distal radius fracture. The DVR plate applied through the extended flexor carpi radialis approach allows the volar management of complex distal radius fractures regardless of their direction of instability. This technique provides stable internal fixation and allows early function while avoiding the extensor tendon problems that have plagued dorsal plate fixation.

Methods: We treated 127 patients presenting with 136 unstable distal radius fractures, mostly dorsally displaced. The fractures were classified according to the Comprehensive Classification of Long Bone Fractures and to the direction of instability. We used the extended flexor carpi radialis approach, an extension of the classic flexor carpi radialis approach in which dorsal exposure is obtained by releasing the radial septum and mobilizing the proximal radius. It provides sufficient exposure to manage articular displacement, apply bone graft, and treat nascent malunions. Internal fixation was provided by the DVR plate, which is a fixed-angle device designed for volar fixation of dorsally unstable distal radius fractures.

Results: We followed up the patients for an average of 27 weeks, and the clinical results were evaluated radiographically and functionally. The average final range of motion was 60° of dorsiflexion, 58° of volar flexion, 82° of pronation, and 79° of supination, and the grip strength was 77% of that of the contralateral side. No external fixation was needed. Functional use of the hand was allowed in the first postoperative week, and splinting was used for as long as 4 weeks. There were no cases of plate failure or loss of reduction. Complications consisted of one case of dorsal tendon irritation from an excessively long peg, treated by implant removal, and two cases of transient regional pain syndrome.

Conclusion: The treatment of unstable distal radius fractures with internal fixation is possible with the use of the DVR plate and the extended flexor carpi radialis approach. This technique allows for early function, presents a low complication rate, and minimizes tendon problems.