Volar approach, fixed angle plate successful for distal radius fractures

Retrospective study of intraarticular fractures found good pain, functional activity levels.

Issue: November 2004

ASSH 2004 New York [icon] Intraarticular fractures of the distal radius were treated successfully with a single volar incision and the insertion of a fixed angle plate.

Researchers led by Jorge Orbay, MD, of the Miami Hand Center, performed a retrospective study of 51 patients with intraarticular distal radius fractures. Patients were treated between January 2000 and March 2002 and ranged in age from 18 to 73 years; the average age was 48.3. Orbay presented the findings at the American Society for Surgery of the Hand 59th Annual Meeting.

Fifty-one patients fit the inclusion criteria; 48 patients with 50 intraarticular distal radius fractures were available for an average follow-up of 14.5 months (13 to 20 months). Radiographic fracture parameters were measured at final follow-up, and functional results were measured by assessing digital motion, wrist motion and grip strength. Three patients were lost to follow-up. The results were scored using the Disabilities of the Arm, Shoulder and Hand system.

Good outcomes

According to the abstract, outcomes in terms of patient satisfaction, pain and activity levels were very good. Radiographic assessment indicated an average volar tilt of 6º and a radial tilt of 20º. There was an average articular displacement of less than 1 mm and radial shortening of 1 mm. Patients’ wrist extension averaged 54º, volar flexion averaged 52º, pronation averaged 77º and supination averaged 72º.

Orbay said that this surgical method is less difficult to perform than other methods. “I think it’s easier. There’s a trick to it, and the trick is to release the soft tissues — including the brachioradialis tendon, and to debride the fracture. If you don’t do that, it is difficult to perform this operation,” he told Orthopedics Today in a phone interview. “The extended approach is a new perspective on the distal radius that will allow a surgeon to get to the dorsal aspect of the fracture from the volar approach.”

No nonunions

According to Orbay, one patient required revision surgery, but there were no other complications. “There were no nonunions,” he said. “There was one case in which there was a loss of fixation, and it needed a reoperation. It was a very complex and difficult case … the patient needed a wider plate, and that was addressed later on. All other patients basically had an anatomical reduction and maintained anatomical reduction.”

The fixed angle plates used were made by Hand Innovations. “There are other volar fixed angle plates on the market, but Hand Innovations makes the plate I used for this study,” he said. “In my opinion it is the only one that gives all the benefits that allow you do this operation. You have to create a very specific scaffold underneath the articular surface, and you have to place the pegs in a very particular manner, otherwise it won’t support a commuted fracture adequately.”

Dr. Orbay has a financial interest in the product mentioned in this article and is a paid consultant for Hand Innovations.
For more information:

Orbay JL, Fernandez DL. The management of intra-articular fractures of the distal radius through a volar approach. #20B. Presented at the American Society for Surgery of the Hand 59th Annual Meeting. Sept. 9-11, 2004. New York.