The Flexor Carpi Radialis Portal for Arthroscopy-Assisted Reduction of the Dorsal Ulnar Fragment in Distal Radius Fractures

Background The importance of the dorsal ulnar fragment (DUF) for stability and articular congruence of the radius is widely recognized, and standard surgical techniques often fail to ensure its reduction. Description of Technique We describe a modification of volar wrist portals for arthroscopic management of the DUF of the distal radius. It is made in an outside-in fashion in line with the flexor carpi radialis (FCR) approach for the distal radius. Through this volar portal, we achieve wide and direct visualization of the DUF, with the advantage of protecting important anatomic structures such as the FCR tendon, the radial artery, and the median nerve; all protected with the previously made volar approach for the distal radius. In addition, easy manipulation and reduction of the DUF is obtained with instrumentation through standard dorsal portals. Patients and Methods We performed this procedure in 23 patients with distal radius fractures (DRF) with displaced DUF. Results Early and late postoperative evaluation demonstrated intraoperative reduction maintenance and adequate range of motion, compatible with the usual findings of standard volar plating, with the benefit of anatomic reduction of the DUF. Conclusion With our technique, volar plating associated with arthroscopy-assisted dorsal fragment specific fixation with dorsal standard and the FCR portals permits optimal surgical treatment of most DRFs.

Study of treatment for distal end radial fractures by open reduction and internal fixation with volar locking compression plates

Introduction: For dorsally displaced lower end radius fractures percutaneous pinning fixation and insome studies fragment specific fixation shows their advantages. For volarly displaced fracturesvolarly plate fixation traditionally showed good results. The volar locking plates with their inheritanceability to provide absolute stability are attractive for their advantages. Objective: To assess thefunctional outcome of treating the distal end radius fractures with the use of volar lockingcompression plates. Materials and methods: Study of a total of 30 patients was conducted in thedepartment of orthopedics at G K General Hospital, Bhuj, Gujarat. All 30 patients with closedfractures were included in the study. All patients were treated with open reduction and internalfixation with the use of a volar locking compression plate. The patients were followed up at one, two,three, and up to six months. Mayo wrist scoring system was used to assess final functional outcomesof treatment. Results: At the final functional assessment, as per mayo wrist scoring out of a total of30 patients, 17 of them achieved excellent, 7 achieved good outcomes, with 5 patients exhibitingfair results and one patient had the collapse of fixation at the 3-month review. No, any patient haddiminution of functional outcome. On radiological assessment, 70% of patients had callus formationand no clear fracture line was seen, 18% had callus formation but a visible fracture line was presentand 12% of patients had clear visible fracture line up to final follow up. Conclusion: Open reductionand internal fixation with volar locking compression plating is a safe and effective treatment forunstable especially volarly displaced fractures of distal end radius with satisfactory functionaloutcome.