Reduction of fragments, distal radioulnar joint improves distal radius fracture volar plating results

LAS VEGAS — Reducing a distal radius fracture by fixing it with a volar plate can be optimized by keeping in mind concepts, like accuracy of the reduction and ensuring the distal radioulnar joint is reduced, a presenter said at the American Academy of Orthopaedic Surgeons Annual Meeting.

“If you are going to fix a distal radius fracture with volar plate, the main advantage, if any, is early return to function,” Michael D. McKee, MD, FRCS(C), of Phoenix, said here, during a symposium about decision-making in regard to distal radius fracture management.

Accurate fracture reduction, either with a volar plate or another approach, impacts the patient’s functional outcome, he noted, saying casting a patient for 6 weeks after appropriately reducing the fracture is counterproductive and negates the benefits of the surgery.

“If present, reduce and support the volar ulnar fragment,” McKee, who is an Orthopedics Today Editorial Board Member, said. “So, that’s a bit of a technical thing, but that small piece of the whole carpus can dislocate and, if you are going to fix it, you should fix that fragment.”

He continued, saying, “Don’t penetrate the dorsal cortex with screws. Don’t go past the watershed line and have that rupture. Make sure the [distal radioulnar joint] DRUJ is reduced.”

McKee also reviewed some points he found mentioned in the literature related to outcomes after volar plating. These included making the patient’s wrist straight and extended out to its full length, avoiding complications and having the patient’s DRUJ “look good when you’re done. If you are going to fix somebody, move them early so they reap the benefits of the intervention that you’ve chosen to do,” he said. – by Susan M. Rapp

Reference:

McKee MD. Volar locked plating: How to optimize the reduction and the fixation construct. Presented at: American Academy of Orthopaedic Surgeons; March 12-16, 2019; Las Vegas.

Disclosure: McKee reports he is a paid consultant for Acumed, Bioventus and Nexsens; receives IP royalties from and is a paid consultant for ITS and Stryker; and receives research support from Zimmer.