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

• Radiological evidence of instability, best analyzed using accident X-ray images, additionally CT in case of intra-articular involvement
• dorsal tilt > 5° or ulnar inclination > 20°, compared to the healthy opposite side
• palmar or dorsal comminution
• dislocated intra-articular fracture with step formation > 2 mm
• radial shortening > 5 mm
• accompanying ulna fracture
• severe osteoporosis
• articular rim fractures (dorsal and palmar Barton's fracture)
• Fracture with ulno-palmar key fragment (critical corner = palmar lunate facet). This fragment includes the radiolunate ligament, which must be surgically fixed to avoid palmar carpal subluxation.
• dislocated extra-articular fracture with comminution (Smith's fractures)
• Die-punch fractures
• secondary loss of correction after primary repositioning and plaster immobilization

• local or general conditions that surgically or anesthesiologically contraindicate an elective operation or can be improved preoperatively
• insufficient soft tissue coverage in open fracture

• Medical history of the typical clinical presentation:
  Trauma involving the wrist
• classic fracture signs (axial deviation, increased mobility, open fracture, step formation, bone gap, crepitation)
• Exclusion of a median nerve lesion
• radiological detection using X-ray examination of the wrist in AP and lateral views, if necessary CT (fracture analysis, surgical planning)

• no special preparation of the patient necessary
• depending on accompanying circumstances, plannable as outpatient or short inpatient procedure
• Clarification of contraindication for bloodless field (e.g. existing shunt in dialysis)

• Information about the surgical method
• Information about extension procedures such as e.g. external fixator 
• Information about general surgical risks (wound healing disturbance, keloid, infection, hematoma)

Information about specific surgical risks

• Pseudarthrosis 
• Loosening of the osteosynthesis material
• Injury to median nerve, palmar branch  (direct or as traction injury)
• Tendon injury due to screws that are too long (EPL) or due to friction on the plate (FPL)
•  Loss of correction with healing in malalignment
• protracted scar pain (usually subsides after 6 months)
• persistent symptoms
• Revision procedure
• Functional deficit of the wrist/hand
• CRPS (rare)