Minimally Invasive Plate Osteosynthesis of Distal Radius Fractures

Abstract The goal of this study was to evaluate the midterm results of a minimally-invasive technique of volar plate fixation of distal radius fractures. A case series of 710 patients, among which 512 women, aged 58 years in average were reviewed retrospectively. A 15-mm incision was performed on the lateral aspect of the flexor carpi radialis and the plate positioned under the pronator quadratus. The incision was closed using a running subcuticular absorbable suture without drainage or immobilization. At 7 months of average follow-up, the average size of the scar was 17 mm (10–40), the average pain 1.13/10 (0–8), the average Quick-DASH 13.28 (0–86.36), the average PRWE 11.48 (0–91). In % compared to the contralateral side, the average flexion was at 87.23%, the average extension at 88.52%, the average pronation at 96.17%, the average supination at 93.41% and the average grip strength at 79.68%. The removal of the plate was performed in 45.92% of cases. Among the complications, we noted 16 cases of secondary displacements of which 3 cases required a surgical revision, 1 case of sepsis at 6 months in a context of general sepsis, 10 cases of type I Complex Regional Pain Syndrome and 14 cases of paresthesia in the territory of the median nerve of which 4 cases required a neurolysis of the median nerve at the carpal tunnel. In conclusion, the minimally-invasive approach of the flexor carpi radialis can be used for volar plate fixation of distal radius fractures. The upsides of this technique are the preservation of the ligamentotaxis to facilitate the reduction of the fracture and the small size of the incision to improve the cosmetic results of the procedure. The incision can always be extended in case of difficulties of reduction.