gms | German Medical Science

Objectives/Interrogation: Distal radius fractures are the third most common type of fragility fractures, following vertebral and proximal femur fractures. There has been an increasing trend towards surgical fixation, although most fractures are treated non-operatively. Minimally-invasive surgical approaches have been described before. However, a single transverse incisional approach to distal radius fractures has never been published.

Methods: A retrospective case series of patients undergoing distal radius fracture fixation via a single transverse wrist incision. The surgeries were performed by a fellowship trained hand surgeon, between July 2015 and August 2016. All patients underwent the institution-specific standard post-operative rehabilitation regimen for distal radius fractures.

Results and Conclusions: There were 16 patients with a total of 17 fractures. The mean age of patients was 58 years old. 11 out of 16 patients were females. The most common fracture type was the AO 23-A3. At 3 months post-surgery, the mean range of wrist motion showed a flexion of 52 degrees, extension of 60 degrees, pronation of 80 degrees, supination of 83 degrees, radial deviation of 17 degrees and ulnar deviation of 33 degrees. Mean grip strength was 67% of the contralateral side. Radiographic parameters showed a mean post-operative improvement of 6.9 degrees in radial inclination, 2.0 mm in radial height, and 26.9 degrees in volar tilt. All patients returned to pre-injury work within 3 months after surgery. There was one incidence of superficial wound cellulitis, which resolved with oral antibiotics. The patients were satisfied with the appearance of the surgical scar. Clinical and radiological parameters were maintained in the 11 patients that were followed up 1 year post-operatively. Average grip strength at 1 year was 78% of the unaffected side.

The single transverse wrist incision approach to distal radius fractures is a viable alternative which provides an aesthetically pleasing scar which blends with the wrist crease. There was better exposure of the ulnar corner of the distal radius during fracture fixation. Post operative range of motion and radiographic parameters were comparable to published literature of conventional volar approach at 3 months and 1 year post surgery. There maybe a learning curve for this new approach and care should be taken during retraction of the skin.