The management of distal radius fractures has dramatically improved due to the development of a locking plate system. In addition, mini-invasive surgery has been performed in a lot of surgical fields in recent years. The aim of the present study is to investigate the possibility of fixation of a distal radius fracture with a volar locking plate through a 10 mm approach. Eighteen patients with distal radius fracture (mean age: 66 y; range, 28 to 88 y; 8 males and 10 females) were operated on using a volar locking plate. The incision for plating was always 10 mm long. The clinical, cosmetic, and radiologic outcomes were investigated. At 3 months' follow-up, the range of motion of the wrist joint was 67.5 degrees in flexion, 65.6 degrees in extension, 88.3 degrees in pronation, and 88.3 degrees in supination. The % grip strength compared to the healthy side ranged from 35% to 100%. The VAS, Q-DASH, and modified Mayo scores were 0.7, 8.5, and 93.3, respectively (excellent in all 18 patients). Bone union was achieved on plain x-ray radiography and cosmetic problems were satisfied in all patients. Our results suggest that it is possible to achieve fixation of a distal radius fracture with a volar locking plate through a 10 mm approach. However, its applicability to surgery must be carefully examined. If any difficulties in plate installation or approach occur during this intervention, it will be necessary to consider switching to a conventional approach. We believe that surgeons must not adhere to a mini-invasive approach.

Recent reports suggest the presence of a rare fracture type for which reduction and fixation cannot be achieved with volar locking plate (VLP). In particular, it is difficult to achieve reduction and fixation with volar lunate facet (VLF) fragments present on the volar ulnar aspect of the lunate facet, because of the anatomical structure and biomechanics in this region. Herein, we report two challenging cases of difficulty in fixation of the VLF fragment in distal radius fracture. For this fracture type, it is most important to identify the volar ulnar bone fragment before surgery; it may also be necessary to optimize distal placement of the VLP via a dual-window approach and to apply additional fixations, such as a small plate, anchor, and/or external fixation.

No abstract