Standardized reduction and palmar plating of dorsally displaced distal radius fractures for safe and atraumatic reconstruction of the anatomy of the radius

Oper Orthop Traumatol. 2023 Dec 5. doi: 10.1007/s00064-023-00838-2. Online ahead of print.ABSTRACTOBJECTIVE: Standardization of palmar plate osteosynthesis in order to consequently achieve physiologic anatomy of the distal radius end.INDICATIONS: Unstable dorsally displaced distal radius fractures or fractures that should be treated functionally.CONTRAINDICATIONS: Severe intraarticular joint depression that cannot be reduced with either a palmar or arthroscopic assisted approach.SURGICAL TECHNIQUE: Patient in supine position with the forearm supinated on arm table. Radiopalmar incision along the radial border of the flexor carpi radialis tendon. Detachment of the pronator quadratus muscle from radial to ulnar. Gross reduction with eventual correction of a dorsal or radial shift. Placement of the angular stable plate and preliminary fixation with a nonangular stable cortical screw in the long hole at the radius shaft. Fluoroscopic control of axial alignment in the anteroposterior view and of correct distal position of the plate in the lateral view under reduction condition. Placement of one or two angular stable screws at the shaft. Under subtle reduction with flexion, ulnar deviation and axial traction placement of two K‑wires via the holes at the distal edge of the plate. These wires mostly keep reduction maintained while reduction maneuver can be paused. Fluoroscopic control in two planes. Replacement of the wires by distal angular stable screws with the help of the wires...
Source: Operative Orthopadie und Traumatologie - Category: Orthopaedics Authors: Source Type: research