J Korean Soc Surg Hand.  2015 Jun;20(2):77-84. 10.12790/jkssh.2015.20.2.77.

Dorsal Approach for Distal Radius Fractures

• Kwon HB
• Lee JS

• KMID: 2194104
• DOI: http://doi.org/10.12790/jkssh.2015.20.2.77

Abstract

Since the advent of volar locking plate, volar approach for internal fixation has become a major trend in the treatment for unstable distal radius fracture. However, dorsal approach is preferred for certain fracture pattern include AO type C3, dorsal Barton's fractures and concomitant intercarpal ligament injury, because it can afford excellent exposure of the articular surface. Although dorsal approach and plating technique has inherent disadvantages include extensor tendon irritation and rupture, improvements in implant design lead to decrease complication rate. Here, we provide overview of the pros and cons through historic perspective, indications, and surgical technique of the dorsal approach for the distal radius fracture.

Keyword

Distal radius fracture; Dorsal approach

MeSH Terms

Ligaments
Radius Fractures*
Rupture
Tendons
Palmar Plate

Figure

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  Fig. 1. Recent dorsal plate. (A) AO (Depuy Synthes) dorsal plate. (B) Acumed dorsal plate.

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  Fig. 2. Combined volar and dorsal plating (dual plating). (A) Preoperative radiographs of a 52-year-old women after slipping and landing to outstretched arm. Note the comminuted dorsal Barton type fracture. (B) Twelve months postoperative anterior-posterior (AP) and lateral radiograph displaying anatomical reduction with the dual plate. (C) Preoperative radiographs of a 56-year-lod women after fall from the stair. Note the severe comminuted articular and metaphyeal fracture, AO type C. (D) Fifteen months postoperative AP and lateral radiographs displaying stable dual plate fixation.

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  Fig. 3. Dorsal approach. (A) Dorsal longitudinal skin incision along just ulnar side to Lister tubercle (B) exposed the extensor retinaculum and incised over the third extensor compartment. Needle tip indicated the extensor policis longus. (C) Optional retinacular incision method. (D) Exposed the fracture site after elevation of the second, fourth extensor compartment.

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  Fig. 4. Dorsal plating technique. (A) Applied appropriate dorsal plate after fracture reduction and temporary fixation. (B) Fixation plate with 2.7 mm conventional screw proximally and 2.4 mm locking screw distally. (C) The extensor policis longus is left dorsal to the extensor retinaculum to minimize tendon scarring. (D) Postoperation radiographs.

Reference

References

1. Robertsson GO, Jonsson GT, Sigurjonsson K. Epidemiology of distal radius fractures in Iceland in 1985. Acta Orthop Scand. 1990; 61:457–9.

2. Chung KC, Shauver MJ, Yin H, Kim HM, Baser O, Birkmeyer JD. Variations in the use of internal fixation for distal radial fracture in the United States medicare population. J Bone Joint Surg Am. 2011; 93:2154–62.

3. Tavakolian JD, Jupiter JB. Dorsal plating for distal radius fractures. Hand Clin. 2005; 21:341–6.

4. Ring D, Prommersberger K, Jupiter JB. Combined dorsal and volar plate fixation of complex fractures of the distal part of the radius. J Bone Joint Surg Am. 2004; 86:1646–52.

5. Axelrod TS, McMurtry RY. Open reduction and internal fixation of comminuted, intraarticular fractures of the distal radius. J Hand Surg Am. 1990; 15:1–11.

6. Rozental TD, Beredjiklian PK, Bozentka DJ. Functional outcome and complications following two types of dorsal plating for unstable fractures of the distal part of the radius. J Bone Joint Surg Am. 2003; 85:1956–60.

7. Yu YR, Makhni MC, Tabrizi S, Rozental TD, Mundanthanam G, Day CS. Complications of low-profile dorsal versus volar locking plates in the distal radius: a comparative study. J Hand Surg Am. 2011; 36:1135–41.

8. Carter PR, Frederick HA, Laseter GF. Open reduction and internal fixation of unstable distal radius fractures with a low-profile plate: a multicenter study of 73 fractures. J Hand Surg Am. 1998; 23:300–7.

9. Kamath AF, Zurakowski D, Day CS. Low-profile dorsal plating for dorsally angulated distal radius fractures: an outcomes study. J Hand Surg Am. 2006; 31:1061–7.

10. Kambouroglou GK, Axelrod TS. Complications of the AO/ASIF titanium distal radius plate system (pi plate) in internal fixation of the distal radius: a brief report. J Hand Surg Am. 1998; 23:737–41.

11. Ruch DS, Papadonikolakis A. Volar versus dorsal plating in the management of intra-articular distal radius fractures. J Hand Surg Am. 2006; 31:9–16.

12. Rikli DA, Regazzoni P. Fractures of the distal end of the radius treated by internal fixation and early function. A preliminary report of 20 cases. J Bone Joint Surg Br. 1996; 78:588–92.

13. Campbell DA. Open reduction and internal fixation of intra articular and unstable fractures of the distal radius using the AO distal radius plate. J Hand Surg Br. 2000; 25:528–34.

14. Geissler WB. Management distal radius and distal ulnar fractures with fragment specific plate. J Wrist Surg. 2013; 2:190–4.

15. Lutsky K, Boyer M, Goldfarb C. Dorsal locked plate fixation of distal radius fractures. J Hand Surg Am. 2013; 38:1414–22.

16. Wei J, Yang TB, Luo W, Qin JB, Kong FJ. Complications following dorsal versus volar plate fixation of distal radius fracture: a meta-analysis. J Int Med Res. 2013; 41:265–75.

17. Osada D, Viegas SF, Shah MA, Morris RP, Patterson RM. Comparison of different distal radius dorsal and volar fracture fixation plates: a biomechanical study. J Hand Surg Am. 2003; 28:94–104.

18. Letsch R, Infanger M, Schmidt J, Kock HJ. Surgical treatment of fractures of the distal radius with plates: a comparison of palmar and dorsal plate position. Arch Orthop Trauma Surg. 2003; 123:333–9.

19. Kim JK, Cho SW. The effects of a displaced dorsal rim fracture on outcomes after volar plate fixation of a distal radius fracture. Injury. 2012; 43:143–6.

20. Ikeda K, Osamura N, Tada K. Fixation of an ulnodorsal fragment when treating an intra-articular fracture in the distal radius. Hand Surg. 2014; 19:139–44.

21. Na KT, Song SW, Lee YM, Kang BM. Dorsal plate fixation for dorsally displaced distal radius fractures. J Korean Soc Surg Hand. 2014; 19:44–51.