Use of Volar Plate for Indirect Coronal Plane Reduction in an Intraarticular Distal Radius Fracture

Abstract

Management of intraarticular distal radius fractures requires precise reconstruction of the articular surface to optimize outcomes. Treatment goals also include restoration of alignment, rotation, and angulation in both the coronal and sagittal planes of the metaphyseal component of these fractures. Surgical management with open reduction and internal fixation with a volar plate is often the preferred method of open treatment. However, a variety of different techniques have been described, and the preferred technique may be determined on an individual basis by the fracture characteristics, patient-dependent factors, or surgeon experience.

Reduction Techniques in Volar Locking Plate Fixation of Distal Radius Fractures

“…Next, the distal row of subchondral locking screws is placed to neutralize the distal fragment(s), functionally creating an extra-articular fracture. At this point the lobster claw method can be implemented to apply a rotational force to direct the ulnarly translated radial shaft radially to match the distal fragment 42. Alternatively, 2 freer elevators, one on the proximal ulnar aspect and one on distal radial aspect of plate, are used to rotate the plate, thereby translating the distal articular block ulnarly to restore coronal alignment 43,44.…”

“…At this point the lobster claw method can be implemented to apply a rotational force to direct the ulnarly translated radial shaft radially to match the distal fragment. 42 Alternatively, 2 freer elevators, one on the proximal ulnar aspect and one on distal radial aspect of plate, are used to rotate the plate, thereby translating the distal articular block ulnarly to restore coronal alignment. 43,44 An interosseous lamina spreader can be inserted between the radial and ulnar shafts if further translation of the radial shaft is needed.…”

Open Reduction Maneuver for Distal Radius Fracture Involving an Intra-articular Sagittal Split

“…Several intraoperative reduction maneuvers have been described, and anyone may be helpful depending on the specific deformity encountered. [1][2][3][4] We propose a novel, plate-assisted reduction maneuver to more adequately reduce the articular surface.…”