Technique Spotlight: ORIF of Intra-Articular Distal Radius Fractures—Volar Approach

Introduction

It is important to try and achieve as close as an anatomic reduction of the articular surface as possible, especially in a young patient, in the management of intra-articular distal radius fractures to reduce the chance of posttraumatic radiocarpal arthritis. ^, Visualization of the radiocarpal articular surface was historically performed through a dorsal approach to the distal radius fracture via a dorsal capsulotomy. With the advent of volar locking plates, many surgeons now prefer to fix an intra-articular fracture through a volar approach. ^,

Confirmation of the reduction of the articular surface is typically performed using fluoroscopy. This is an indirect assessment of the articular cartilage reduction and can underestimate the step-offs or gaps of the articular surface. ^{, ,} Wrist arthroscopy can be used to confirm, measure, and assist in articular reduction; assess intercarpal ligaments and the triangular fibrocartilage complex (TFCC); and has been shown to demonstrate significant step-offs and gaps not identified radiographically. Abe et al. evaluated 155 wrists arthroscopically during distal radius fracture fixation after reduction was achieved using fluoroscopy. They found residual intra-articular gaps or step-off >2 mm in 35.2% of patients. In addition, they found scapholunate ligament and TFCC injury in 28.9% and 63.2% of patients, respectively. The use of arthroscopy allows a magnified, high-resolution view of the articular surface to guide reduction compared to the indirect method of fluoroscopy. ^{, ,} The use of arthroscopic-assisted reduction has correlated with improved patient-reported outcomes, wrist and forearm motion, and radiographic alignment compared to fluoroscopy.