ORIF Distal Radius (Volar)
64 year old woman who fell off horse – completely volarly displaced, intra-articular fracture of the distal radius, with ulnar styloid fracture.
Positioning: Supine, Boyse table
Regular prep and drape, with the arm out on the table. The tough part is to ensure that you get enough proximal exposure to put the plate on. Make the incision straight just ulnar to FCR. He does not continue the incision across the transverse crease of the wrist. Cauterize the little veins that come into view in the subcutaneous tissue. Find the tendon sheath of FCR and incise along the radial aspect of it. If you go too radial you’ll incise the radial artery. Mobilize the tendon ulnarly. Incise the undersurface of the tendon sheath. All of the muscles – FPL and FDP are then mobilized ulnarly until you reach pronator quadratus. This is incised along its radial border and peeled subperiosteally ulnarly. This should get you into the fracture hematoma and fracture. Subperiosteal dissection distally gets you into the capsular attachments. Proximal dissection is required to get the plate on.
Bend a bit of spring into the plate, then use it to buttress the distal fragment back on. Secure the shaft, then put a cancellous screw into the distal fragment.