Angle-stable palmar plate osteosynthesis of a distal radius fracture on the right

The CT scan shows a displaced metaphyseal fracture of the distal radius with an additional ulno-palmar key fragment and a shell-like avulsion of the dorsal radius edge.

Radio-palmar approach to the distal radius radial to the tendon of the flexor carpi radialis muscle from the distal palmar crease approximately 8-10 cm proximally. Preparation through the fascia antebrachii at the level of the tendon sheath. The radial artery and, by shifting all finger flexor tendons ulnarly, the median nerve including the palmar branch of the median nerve are safely preserved.

The pronator quadratus muscle is transected transversely to the direction of its fibers at its radial insertion and completely dissected from the palmar surface of the radius as an ulnar pedicled flap.

Tip

Crossing the flexor crease and an ulno-palmar approach should be strictly avoided, as this is associated with a high incidence of scar contracture and injury to the palmar branch of the median nerve.

Guiding Structures

• Distal palmar crease
• Tendon of the flexor carpi radialis
• Median nerve with palmar branch
• Radial artery

The plate bed is exposed subperiosteally at the distal radius, without opening the periosteal tube. This keeps the individual fragments in the compound. Under traction in hyperextension and utilizing ligamentotaxis, the metaphyseal part of the fracture is manually reduced.

Tip

During reduction, special attention should be paid to the restoration of:

• Length ratio between the radius and ulna
• Elimination of steps in the radial joint surface
• Compensation of the existing radial displacement
• Malrotation of the distal fragment