Podcast
Questions and Answers
What is the first step in the manual reduction technique for a distal radial fracture?
What is the first step in the manual reduction technique for a distal radial fracture?
- Apply the plate to the proximal radial fragment.
- Confirm the position using imaging.
- Insert a screw through the distal fragment.
- Apply the plate to the bone. (correct)
Where should the distal end of the plate be positioned during the procedure?
Where should the distal end of the plate be positioned during the procedure?
- At the ulnar side of the radius.
- Outside the fracture site.
- At the proximal radial fragment.
- At the anatomical watershed zone of the distal radius. (correct)
What structure is located deep to the flexor sheath during the surgical approach?
What structure is located deep to the flexor sheath during the surgical approach?
- Pronator teres.
- Supinator muscle.
- Flexor carpi ulnaris.
- Pronator quadratus. (correct)
What is a key consideration when inserting the initial screw for plate stabilization?
What is a key consideration when inserting the initial screw for plate stabilization?
What is the purpose of using K-wires during the manual reduction technique?
What is the purpose of using K-wires during the manual reduction technique?
How should the angle of the plate correspond to the shaft of the radius?
How should the angle of the plate correspond to the shaft of the radius?
What is vital to confirm after inserting screws during the fixation process?
What is vital to confirm after inserting screws during the fixation process?
What should be done if the position of the distal fragment needs adjustment?
What should be done if the position of the distal fragment needs adjustment?
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Study Notes
Extra-Articular Distal Radial Fracture
- 20-year-old male patient with dorsal displacement extra-articular distal radial fracture
- CT images indicate extra-articular fracture with dorsal Comminution
Surgical Approach
- Approach: Volar Henry approach through the flexor carpi radialis
- Flexor sheath opened
- Pronator quadratus dissected and reflected to expose fracture
Reduction Techniques
- Manual reduction and preliminary fixation with K-wires
- Reduction with plate
Manual Reduction and K-wire Fixation
- Plate applied to bone - distal end ending at the watershed zone of the distal radius
- Screw inserted through oblong hole in the proximal radial fragment
- Intraoperative imaging used to check plate position before fully tightening screw
Plate Reduction
- Plate applied to distal fragment - distal end ending at the watershed zone of the distal radius
- K-wire inserted through screw hole parallel to the articular surface as close to the subchondral bone as possible
- Plate angle to radial shaft should equal the angle of displacement
- Image intensification used to confirm position
- Initial screw inserted in most ulnar screw hole
- Screw position confirmed with lateral view under image intensification at 20° to the true lateral to visualize the joint surface.
- At least 2 other distal locking head screws inserted
- Plate brought onto the shaft and held with a clamp
- Check radiographs obtained and distal fragment position adjusted if necessary by moving plate
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