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

Anatomy Perioperative management Technique Complications Evidence Total Video

Content

Planning the Operation
Approach modified according to Henry
Reposition
Osteosynthesis: epiphyseal fragment
Osteosynthesis: meta- and diaphyseal fragment
Irrigation and skin suture

Authors

Gerald Trottenberg

Facharzt für Orthopädie und Unfallchirurgie

Chirurgische Praxis Gerald Trottenberg

Date

date of publication: 15.04.2023

Planning the Operation

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The CT scan shows a dislocated metaphyseal fracture of the distal radius with an additional ulno-palmar key fragment as well as a shell-shaped avulsion of the dorsal radius rim.
Approach modified according to Henry
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Radio-palmar access to the distal radius radial to the tendon of the M. flexor carpi radialis from the distal palmar crease approximately 8-10 cm proximally. Preparation through the antebrachial fascia at the level of the tendon sheath. In doing so, the A. radialis and, by displacing all finger flexor tendons ulnarly, the N. medianus including the palmar branch of the median nerve are safely spared.
The M. pronator quadratus is transected transversely to the fiber direction in the area of its radial attachment and prepared in its entirety from the palmar surface of the radius as an ulnarly pedicled flap.
Tip
A crossing of the flexion crease as well as an ulno-palmar approach should be absolutely avoided, as this is associated with a high incidence of scar contracture as well as injury to the palmar branch of the median nerve.
Guiding structures
- Distal palmar crease
- Tendon of the flexor carpi radialis
- N. medianus with palmar branch
- A. radialis
Reposition
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The plate bed is exposed subperiosteally at the distal radius, without opening the periosteal tube. This keeps the individual fragments connected. Under traction in hyperextension and utilizing ligamentotaxis, the metaphyseal part of the fracture is manually repositioned.
Tip
During repositioning, special attention should be paid to the restoration of:
- Length relationship between radius and ulna
- Elimination of steps in the radial articular surface
- Compensation of the existing radial offset
- Malrotation of the distal fragment