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

Dorsal Approach for Distal Radius Fractures

Affiliations
  • 1Department of Orthopedic Surgery, Chung-Ang University Hospital, Chung-Ang University School of Medicine, Seoul, Korea. boneman@cau.ac.kr

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

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

  • 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.

  • 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.

  • 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

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