gms | German Medical Science

Objectives/Interrogation: Displaced distal radial fractures are commonly internally fixed with a volar locking plate using a moderate sized incision with pronator quadratus raised at its radial insertion. Minimally invasive techniques have evolved using a small incision and sliding the plate under pronator quadratus. The study's aimed to document a series of minimally invasive distal radial fracture fixations, assess the patient's results and comment on the potential relevance of this technique to wrist trauma practise.

Methods: The author performed distal radial fracture fixation of displaced distal radial fractures deemed optimally managed by a volar locking plate over a period of 24 months using a previous published technique with a 15-mm incision and sliding the plate deep to pronator quadratus. Following surgery, patients were provided with a thermoplastic splint for optional use as determined by comfort, and underwent hand therapy.

Data collected included: patient demographics, fracture morphology, fracture reduction, post-operative grips strengths, visual analogue pain scales, DASH scores and complications.

Results: In this series, 25 minimally invasive distal radial fixations occurred. There were 16 females and 9 males with a mean age of 45. Reduction appeared satisfactory with a mean radial inclination post-operatively of 21 degrees and volar tilt of 10 degrees. At six weeks, the average grip strength was 55% of the contralateral side and at 12 weeks it was 70%. One patient ruptured extensor pollicis longus post-operatively with a well reduced fracture and no protruding dorsal metalwork, requiring tendon transfer. Three other patients had their plates removed due to patient preference. No other complications were noted.

Conclusions: The minimally invasive volar plate internal fixation technique is a relatively straightforward technique and with good results. The relevance of this technique modifications for non-hand surgeon practise will be discussed.