DVR Approach & Techniques PDF

Approach & Techniques --------------------- - A 20-year-old male patient with dorsal displacement extra articular distal radial fracture.  - On these CT images, this appears to be an extra-articular facture with some dorsal comminution 1. Approach ========...

Approach & Techniques --------------------- - A 20-year-old male patient with dorsal displacement extra articular distal radial fracture.  - On these CT images, this appears to be an extra-articular facture with some dorsal comminution 1. Approach ======== - Volar Henry approach through the flexor carpi radialis. ------------------------------------------------------- - The flexor sheath is opened.  - Deep to the flexor sheath lies the pronator quadratus on the volar distal radius - Pronator quadratus has been subperiosteally dissected and reflected, exposing the fracture beneath Reduction techniques & Plate insertion ====================================== 1. Manual reduction and preliminary fixation with K-wires 2. Reduction with plate 1. Manual reduction and preliminary fixation with K-wires ====================================================== - Apply the plate to the bone. The distal end of the plate should end at the anatomic watershed zone of the distal radius. - Insert a screw through an oblong hole in the proximal radial fragment. - Before fully tightening it, check the plate position using intraoperative imaging, adjusting the position of the plate as necessary. 2. Reduction with plate ==================== - Apply the plate to the distal fragment. The distal end of the plate should end at the anatomic watershed zone of the distal radius. - Insert a K-wire through a screw hole, [as close to the subchondral bone] [as possible] and parallel to the articular surface. - The angle of the plate to the shaft should equal the angle of the displacement.( B=B1) - Confirm using image intensification. - The **initial screw** is inserted in the most ulnar screw hole. - The reason for this is that **if** the **initial screw** is placed on the **radial** - Provided the screw is parallel to the K-wire, it should not enter the radiocarpal joint. - **Confirm** screw position with a lateral view under image intensification, with the beam aimed at an [angle of 20°] to the [true] [lateral], clearly showing the joint surface. - Insert at least two other distal locking head screws. - Bring the plate onto the shaft and hold it with a clamp. - Obtain check radiographs and adjust the position of the distal fragment if necessary by moving the plate. - Once satisfactory reduction is confirmed, insert a self-tapping, non- locking screw through the oblong plate hole.  - Insert at least two further proximal screws - A variable angle drill guide is used in the distal most screw holes, taking care that the screw trajectory will be **subchondral** and **[not into] [the joint.]** - Fluoroscopic image demonstrating all distal screws are extraarticular. - Lateral fluoroscopic image demonstrating that the screws are - To ensure the radial styloid screw is **extra articular**, a [styloid view] with **20° of angulation** must be performed. 3. Closure ======= - Before skin & subcutaneous closure, the volar plate should be [covered with the pronator quadratus.]  Post Op images ============== - Postoperative CT showing extraarticular position of variable angle screws.