Session VI - Upper Extremity

*The Treatment of Complex Articular Fractures of the Distal Radius through a Volar Approach

Jorge L. Orbay, MD¹ (d-Hand Innovations, Inc.); Alejandro Badia, MD¹ (d-Hand Innovations, Inc.); Igor R. Indriago, MD¹; Eduardo Gonzalez, MD¹ (d-Hand Innovations, Inc.); Roger K. Khouri, MD¹; Diego L. Fernandez, MD²;

¹Miami Hand Center, Miami, Florida, USA;

²Lindenhof Hospital, Bern, Switzerland

Purpose: With the advent of fixed-angle devices, volar fixation of dorsally displaced distal radius fractures is being recognized as a valid treatment option. Complex displaced articular fractures (Fernandez type 3 and 5) are a sub-set of these injuries that present more difficulty in treatment and a worse prognosis. We reviewed our experience in treating complex displaced articular fractures of the distal radius with internal fixation applied through a volar approach.

Methods: We retrospectively reviewed the outcome of patients with complex articular fractures treated at our centers between January 1998 and March 2001. We used the extended flexor carpi radialis approach for exposure, and fixation was provided with the DVR fixed-angle volar plate. Fractures were classified according to Fernandez, Malone, and the "Comprehensive Classification of Long Bone Fractures." At final follow-up, standard radiographic fracture parameters were measured and final functional results were assessed by measuring digital motion, wrist motion, and grip strength.

Results: Of 46 patients fitting the inclusion criteria, we observed 43 patients with 45 intraarticular distal radius fractures for an average of 58 weeks. Three patients were lost to follow-up. Final volar tilt averaged 6°, radial tilt 20°, articular displacement averaged less than 1 mm, and radial shortening also averaged less than 1 mm. The average final dorsiflexion was 55°, volar flexion 53°, pronation 78°, and supination 74°. Grip strength was 83 % of that of the contralateral side. There were no plate failures or significant loss of reduction, slight residual articular malreduction tended to remodel at the 1-year follow-up.

Conclusion: Complex articular fractures of the distal radius can be anatomically reduced through the extended flexor carpi radialis approach, and adequate fixation can be provided by the DVR plate. The technique is somewhat complex and requires attention to detail. Volar fixation of complex articular fractures of the distal radius produces excellent functional results.

* If noted, the author indicates something of value received. The codes are identified as a-research or institutional support; b-miscellaneous funding; c-royalties; d-stock options and e-consultant or employee.