Distal radius fixation through a mini-invasive approach of 15 mm. PART 1: a series of 144 cases

Abstract

The volar Henry approach is becoming the gold standard for distal radius fracture fixation. It decreases the incidence of nonunion, limits complications especially complex regional pain syndrome (CRPS) type I, and allows early mobilization of the wrist. Nonetheless, it has some disadvantages such as the size of the incision, which is not esthetically pleasing, and the loss of ligamentotaxis. This is why some authors have developed a mini-invasive approach. The aim of this work was to evaluate the feasibility of the anterior mini-invasive approach of 15 mm in a clinical series of 144 cases of distal radius fracture. All patients were operated under regional anesthesia using the same techniques by five surgeons of the same team. According to the AO classification, there were 83 type A fractures, 2 type B, and 59 type C. A volar plate (Step One(®), Newclip Technics™, Haute-Goulaine, France) was used in all cases. The 2 proximal metaphyseal screws and the 2 distal central epiphyseal screws were monoaxial locking. The 2 distal ulnar and radial epiphyseal screws were placed in polyaxial locking at 20° angulation maximum. Skin closure without drainage was performed. No postoperative immobilization was prescribed, and patients were encouraged to use their upper limb immediately postoperative. No postoperative physiotherapy was prescribed. The mean follow-up was 4.1 months. The final size of the incision was on average 16.1 mm. Mean pain score was 1.8. The Quick DASH score was average 25. Average range of motion was more than 85 %, and global force of the hand was 67 % compared with contralateral side. On X-ray, the mean radial slope was 22°, the mean radial tilt was 8.3°, and the mean radioulnar variance/index was -0.4 mm. There were nine cases of CRPS type I, which all resolved. Specific complications included two secondary displacements and nine tenosynovitis cases. No tendon rupture was noted. Two intra-articular distal radioulnar joint screws had to be removed at 3 months. One epiphyseal screw required removal 1 month postoperative due to loosening. There were no intra-articular radiocarpal screws. Distal radius fracture fixation using a mini-invasive approach is a reliable and reproducible procedure with few complications. It allows anatomical reduction in the distal radius fractures including intra-articular ones. It can be associated with arthroscopy, scaphoid screw fixation or even percutaneous pinning. Thus, most traumatic lesions of the wrist bony or soft tissue can be treated through this mini-invasive approach.

Transverse or longitudinal? A survey of volar wrist incision preferences

“…However, these studies excluded fractures that were open, multifragmentary, intra-articular, involved neurovascular compromise, had concomitant upper extremity injury or involved systemic multiorgan trauma. (6)(7)(8) For fractures that are amenable to fixation with a transverse approach, the main benefit is that it allows the scar to blend in with the wrist crease and is less noticeable, unlike the longitudinal scar from the traditional Henry approach. (7) Endoscopic carpal tunnel release is performed using a transverse volar wrist crease incision, with varying degrees of patient satisfaction based both on appearance of the scar as well as postoperative pain when compared to the longitudinal open carpal tunnel approach.…”

“…(6)(7)(8) For fractures that are amenable to fixation with a transverse approach, the main benefit is that it allows the scar to blend in with the wrist crease and is less noticeable, unlike the longitudinal scar from the traditional Henry approach. (7) Endoscopic carpal tunnel release is performed using a transverse volar wrist crease incision, with varying degrees of patient satisfaction based both on appearance of the scar as well as postoperative pain when compared to the longitudinal open carpal tunnel approach. (9) Ganglion excision at the wrist and tendon harvesting may also be done using transverse incisions.…”

Long Volar Plating for Metadiaphyseal Fractures of Distal Radius: Study Comparing Minimally Invasive Plate Osteosynthesis versus Conventional Approach

“…been published since 2013 on this subject. [12][13][14][15][16][17][18][19][20][21][22][23] MIPO technique theoretically allows for faster bone healing 15 compared with a conventional Henry's approach 24,25 by preserving pronator quadratus, the periosteum around the fracture, and the blood supply. Cosmetic advantage is obvious.…”

Minimally invasive plate osteosynthesis in distal radius fractures with metaphyseal extension: A series of 13 cases

“…This can be prevented if the tendon is properly retracted; the authors suggest that the interval between the FCR and radial artery is safer than through the FCR sheath; we used this approach in all cases and no tendon damage was observed. Liverneaux et al [27,28] recommended training on cadavers to avoid tendon and joint complications with minimally invasive approaches. In the series, carpal tunnel release and plate removal was needed 12 months after the initial injury in one patient, and one patient needed revision surgery because of a new injury 3 months after the initial surgical procedure.…”