Distal radius fracture is the most common upper limb fracture, accounting for 1/6 of emergency fractures. It is more likely to occur in high-energy injuries in young patients or low-energy ground injuries in older patients. Volar Henry locking plate internal fixation is the “gold standard” for surgical treatment of the distal radius.
Distal radius fracture (Source: “Operative techniques orshopaedic trauma sugery”).
Most distal radius fractures can be treated conservatively with manual reduction. Current indications for surgery include:
Dorsal tilt＞10°.
Radial height loss >5mm.
The change in ulnar declination angle is >5°.
The displacement distance of the articular surface bone fragment or the articular surface step is >2 mm.
Measurement of imaging parameters of the distal radius (Source: “Operative techniques orshopaedic trauma sugery”).
Normal imaging parameters of the distal radius and acceptable parameter ranges for fracture reduction.
Surgical Steps
1.Posture
The supine position is routinely used, with the affected limb abducted and placed on the side operating table.
Schematic diagram of supine position (Source: “AO Principles of Fracture Treatment” (3rd edition)).
The affected limb is abducted, and the visual field can be changed through pronation and supination (Source: DOI: 10.1007/s00064-023-00818-6).
2. Incision and Exposure
The Henry approach is the most commonly used surgical approach on the volar side of the radius. It enters between the radial artery and the flexor carpi radialis muscle and ends distally to the transverse wrist crease (some scholars use a Z-shaped incision or extend it directly).
Gross approach to the distal radius, with direct extension of the distal end (Image source: DOI: 10.1007/s00064-015-0433-5)
Z-shaped incision at the distal wrist crease (Source: DOI: 10.1007/s00064-023-00818-6).
The Henry approach avoids the risk of damaging the median nerve, but avoids damage to the radial artery due to excessive traction during surgery. After exposing the pronator quadratus muscle, make an incision near the radial attachment point, leaving 3 mm for suturing after internal fixation.
3. Reset and Temporary Fixation
The distal end of the radius is reduced through traction, prying, etc., and a Kirschner wire is inserted through the radial styloid process and the palmar side. After temporary fixation, an anatomical plate of appropriate length is inserted. When placing the plate, attention should be paid to the watershed (see: “watershed line” of the distal radius).
4. Internal Fixation and Fluoroscopic Evaluation
Currently, volar anatomical locking plate internal fixation is used to evaluate the reduction and screw position. The wrist is elevated to offset the palmar tilt and ulnar deviation and avoid overlapping of joint surfaces:
As one of the most common osteoporotic fractures, distal radius fracture has a high incidence rate and a large number of cases. Not all distal radius fractures can be treated conservatively. Do not underestimate or simplify it.
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Post time: Mar-23-2024