Surgical Techniques for Distal Radial Fracture

What is the first step in the manual reduction technique for a distal radial fracture?

Where should the distal end of the plate be positioned during the procedure?

What structure is located deep to the flexor sheath during the surgical approach?

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?

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 should be done if the position of the distal fragment needs adjustment?

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

This quiz covers the surgical management of a dorsal displacement extra-articular distal radial fracture, including techniques such as the Volar Henry approach, manual reduction, and K-wire fixation. It also discusses intraoperative imaging for verifying plate position and reduction strategies. Test your knowledge of orthopedic surgical procedures and their implementation.