Volar Approach to Distal Radius Fractures (2023)

Cited by (1)

  • Forearm (Radius and ulna) plating fixation

    2017, Trauma Plating Systems: Biomechanical, Material, Biological, and Clinical Aspects

    The plating fixation of forearm bones fracture is biomechanically and clinically reviewed in this chapter. First, biomechanical aspects of forearm bones and effective muscle-tendons in various positions of the forearm are briefly reviewed. After understanding forearm biomechanics, biomechanical testing methods that could be utilized for evaluation of forearm fracture fixation are explained. Then clinical-biomechanical challenges of forearm plating fixation are explored. In this regard, the associated challenges in volar and dorsal plating fixation methods, plating fixation of fracture with a fragmentary dorsal fracture, plating fixation with variable angle locking system, plating fixation of fracture with radial column fragmentary, irritation of flexor tendons in volar plating fixation, plating fixation of comminuted fractures, etc. are extensively reviewed. Furthermore, clinical considerations that are normally contemplated before, during, and after operation are then elaborated. Finally, overall biomechanical and clinical aspects of forearm plating fixation are discussed.

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    The arthroscopic repair of avulsed triangular fibrocartilage complex generally demonstrates a satisfactory outcome after ruling out additional combined pathologies for ulnar-sided wrist pain. Previous studies have reported that 10% to 20% of patients complain of dissatisfaction with this surgical treatment, suggesting that it is not effective for all patients. Several prognostic factors for poor outcomes such as female gender, chronicity, baseline functional state, and reduced pronator quadratus muscle mass have been proposed. Transosseus foveal repair may be particularly beneficial in chronic cases compared with capsular repair, enhancing the healing rate between the scarred end of the triangular fibrocartilage complex and the bone with greater mechanical strength. However, unaccounted patient variables in uncontrolled small cases series could significantly complicate and confound the point of care application of the findings, and thus larger comprehensive studies are required to confirm these results.

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    Editorial Commentary: Triangular Fibrocartilage Complex “Fovea”—An Attractive and Complicated Structure—Is “The Anchor” Not Only for Distal Radioulnar Joint but Also for Wrist Surgeons

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    A triangular fibrocartilage complex foveal lesion is one of the key structures for stabilizing the distal radioulnar joint. Its anatomy is unique and healing potential is still controversial. If surgical repair is necessary, ulnar abutment is contraindicated, evaluation of the ligament condition using distal radioulnar joint arthroscopy is crucial to achieve satisfactory results.

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    Effect of Electrothermal Treatment on Nerve Tissue Within the Triangular Fibrocartilage Complex, Scapholunate, and Lunotriquetral Interosseous Ligaments

    Arthroscopy: The Journal of Arthroscopic & Related Surgery, Volume 32, Issue 5, 2016, pp. 773-778

    (Video) Volar Locking Plate Distal Radius (Modified Henry's Approach)

    To evaluate the effect of thermal treatment on neural tissue in the triangular fibrocartilage complex (TFCC), scapholunate interosseous ligament (SLIL), and lunotriquetral interosseous ligament (LTIL).

    The intact TFCC, SLIL, and LTIL were harvested from cadaveric specimens and treated with a radiofrequency probe as would be performed intraoperatively. Slides were stained using a triple-stain technique for neurotrophin receptor p75, pan-neuronal marker protein gene product 9.5 (PGP 9.5), and 4′,6-diamidino-2-phenylindole for neural identification. Five TFCC, 5 SLIL, and 4 LTIL specimens were imaged with fluorescence microscopy. Imaging software was used to measure fluorescence signals and compare thermally treated areas with adjacent untreated areas. A paired t test was used to compare treated versus untreated areas. P < .05 was considered significant.

    For the TFCC, a mean of 94.9% ± 2.7% of PGP 9.5–positive neural tissue was ablated within a mean area of 11.7 ± 2.5mm2(P= .02). For the SLIL treated from the radiocarpal surface, 97.4% ± 1.0% was ablated to a mean depth of 2.4 ± 0.3mm from the surface and a mean horizontal spread of 3.4 ± 0.5mm(P= .01). For the LTIL, 96.0% ± 1.5% was ablated to a mean depth of 1.7 ± 0.7mm and a mean horizontal spread of 2.6 ± 1.0mm(P= .02). Differences in the presence of neural tissue between treated areas and adjacent untreated areas were statistically significant for all specimens.

    Our study confirms elimination of neuronal markers after thermal treatment of the TFCC, SLIL, and LTIL in cadaveric specimens. This effect penetrates below the surface to innervated collagen tissue that is left structurally intact after treatment.

    Electrothermal treatment as commonly performed to treat symptomatic SLIL, LTIL, and TFCC tears eliminates neuronal tissue in treated areas and may function to relieve pain through a denervation effect.

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    (Video) Extended FCR Approach for Treating Distal Radius Fractures

    To study the intraobserver and interobserver reliability of the diagnosis of interosseous ligament (IOL) rupture in a cadaver model.

    On 12 fresh frozen cadavers, radial heads were cut using an identical incision and osteotomy. After randomization, the soft tissues of the limbs were divided into 4 groups: both IOL and triangular fibrocartilage (TFCC) intact; IOL disruption but TFCC intact; both IOL and TFCC divided; and IOL intact but TFCC divided. All incisions had identical suturing. After standard instruction and demonstration of radius pull-push and radius lateral pull tests, 10 physician evaluators with different levels of experience examined the cadaver limbs in a standardized way (elbow at 90° with the forearm held in both supination and pronation) and were asked to classify them into one of the 4 groups. Next, the same examiners were asked to re-examine the limbs after randomly changing the order of examination.

    The interobserver reliability of agreement for the diagnosis of IOL injury (groups 2 and 3) was fair in both rounds of examination and the intraobserver reliability was moderate. The intra- and interobserver reliabilities of agreement for the 4 groups of injuries among the examiners were fair in both rounds of examination. The sensitivity, specificity, accuracy, positive, and negative predictive values were all around 70%. The likelihood of a positive test corresponding with the presence of IOL rupture (positive likelihood ratio) was 2.2. The likelihood of a negative test correctly diagnosing an intact IOL was 0.40.

    In cadavers, intraoperative tests had fair reliability and 70% accuracy for the diagnosis of IOL rupture using the push-pull and lateral pull maneuvers. The level of experience did not have any effect on the correct diagnosis of intact versus disrupted IOL.

    Although not common, some failure of surgeries for traumatic elbow fracture-dislocations is because of failure in timely diagnosis of IOL disruption.

Copyright © 2009 Elsevier Inc. All rights reserved.

(Video) Distal Radius Fracture Surgical Treatment. (Step-by-Step Video of the Volar Approach)


What is the surgical approach for a distal radius fracture? ›

In general, there are two palmar surgical approaches to the distal radius– a modified Henry approach to the radius and a more ulnar approach, designed to expose the median nerve as well as the distal radius. The modified Henry approach is suitable for most fractures of the distal radius.

What is Volar approach? ›

The Volar approach to radius, also called Henry approach, offers an excellent and safe exposure of the radius, exposing the entire length of the bone. The Volar approach to radius is used for: ORIF of proximal radius and radial shaft fractures. Radial osteotomy. Tumor/abscess biopsy and excision.

What is volar extensile approach distal radius? ›

The volar-extensile approach requires placement of an incision further ulnar in a longitudinal fashion between the palmaris longus and flexor carpi ulnaris tendons. The incision is brought obliquely across the wrist into the palm for the carpal tunnel release.

How long does it take to recover from volar plate wrist surgery? ›

The actual recovery time after the surgery can vary as well, but it generally takes about two months for the cast to be removed and for the patient to return to almost normal activity level. Most people experience full healing after about one year. Each patient will most likely need to also do some physical therapy.

What is distal radius fracture repair with volar plate? ›

What is it? Distal Radius Fracture Repair with Volar Plate is a surgical procedure used to treat a broken wrist or distal radius fracture. It is a procedure that uses a metal implant to stabilize the fracture.

What is the volar aspect of the radius? ›

The volar aspect of the wrist includes the radius and ulna. The carpal bones are the scaphoid, leonate, triquetrum, pisiform, trapezium,trapezoid,capitate,hamate. An important structure in the volar aspect of the wrist is the Carpal tunnel.

What is the volar side of the wrist? ›

The volar ulnar zone is the front/inside of the wrist on the little finger side.

How do you treat a shaft of radius fracture? ›

Treatment / Management

[14] Isolated radial shaft fractures usually require surgical fixation to maintain adequate anatomic alignment and rotation. Isolated minimal or non-displaced ulnar shaft fractures can be treated nonoperatively with casting or functional bracing and close follow-up and serial examinations.

What is the difference between Henry and modified Henry approach? ›

10 The classic Henry approach requires identification and protection of the radial artery, while the FCR tendon sheath and the palmar cutaneous branch (PCB) of the median nerve are preserved. The modified Henry approach requires incision of the FCR tendon sheath to allow ulnarward retraction of the FCR tendon.

Do all distal radius fractures need surgery? ›

Distal radius fractures do not always require surgery. Many heal just fine without an operation. Minor fractures with minimal displacement do very well with nonsurgical treatment. Other displaced fractures can be “reduced” and casted.

How long does it take to rehab a distal radius fracture? ›

In case of severe trauma, like that caused by a motorcycle crash, some residual stiffness can remain for about 2 years or even permanently. Full distal radius fracture recovery generally takes about a year.

When do you use volar? ›

A volar splint can be used for various injuries, including the following:
  1. Soft-tissue injuries of the wrist and hand.
  2. Fractures of the second, third, and fourth metacarpals.
  3. Fractures of the second, third, and fourth phalanges.
  4. Positioning for rheumatoid arthritis.
  5. Certain wrist fractures, including a pisiform fracture.
Jan 18, 2022

What is a volar brace? ›

Volar splinting is a valuable technique for managing traumatic and non-traumatic conditions of the hand and wrist. The splint immobilizes and supports the metacarpals and carpals while allowing room for swelling. The splint can be removed to examine wounds that may accompany the injury.[1][9][1]

What is the volar part of the hand? ›

Volar plate – A thick ligament on the underside of the middle finger joint. It keeps the finger from hyperextending back. Collateral ligaments – 2 ligaments, 1 on each side of the joint, that control how the finger bends and straightens. They prevent the finger from hyperextending sideways.

How bad is pain after distal radius surgery? ›

Occasionally, after surgery to repair a badly fractured distal radius, complex regional pain syndrome (CRPS) can occur. Be warned – initially the surgery is painful. We try to numb the affected area for about 24 hours after surgery, and then after that the patient will probably feel some discomfort for a few days.

Is a volar plate injury serious? ›

Most volar plate injuries respond well to non-surgical treatment. This includes rest, short periods of splinting and hand therapy. If the damage is severe, the joint is unstable or a fracture is present, surgery may be necessary.

Do you get a hard cast after wrist surgery? ›

After a surgical procedure such as external fixation or internal plate fixation, a cast will not be necessary. Dressing will be applied until wounds heal and a splint is worn to stabilize the wrist. For an external fixation, the wrist will be in a splint for 10 days to allow pain and swelling to subside.

Can you move your wrist with a distal radius fracture? ›

Intense pain is the most common sign of a distal radius break. The pain can become so bad that it becomes almost impossible for you to move your injured wrist or hand. Swelling is also a characteristic of a broken wrist. You may experience limited finger movement or a tingling sensation in your fingertips.

How long does it take to recover from a volar Barton fracture? ›

How long does it take to heal from a Barton fracture? If you don't get surgery, you'll have to wear a cast around your wrist for about six weeks and then go to physical therapy. At therapy, you'll work on your wrist movement and strength. You may feel better in a few months, but healing can take a year.

What is the surgical management of fracture? ›

The three main treatment options for bone fractures are: Casting. Open reduction, and internal fixation- this involves a surgery to repair the fracture-frequently, metal rods, screws or plates are used to repair the bone, and remain in place, under the skin, after the surgery.

What is the surgical approach for Colles fracture? ›

Surgical options can include external fixation, internal fixation, percutaneous pinning, and bone substitutes. A fracture with mild angulation and displacement may require closed reduction. Significant angulation and deformity may require an open reduction and internal fixation or external fixation.

What is a common surgical approach for Colles fracture? ›

The procedure most commonly used is called reduction. During the procedure, an incision is made to allow access to your broken bones. Your surgeon will then realign your bones and close the incision.

What is a volar Barton fracture? ›

Barton's fracture is a fracture dislocation of the distal radius in which either the volar or dorsal aspect of the distal radial articular surface is sheared off with disruption of the radiocarpal joint. It is usually caused by violent direct injury to the wrist.

What approach to use for proximal radius? ›

Proximal radius exposure may be acquired by either the dorsal or volar approach depending on surgical requirements. The dorsal approach is traditionally recommended for fracture fixation of the proximal radius because of theoretically improved exposure and because the dorsal aspect of the bone is the tensile surface.

What is Henry approach? ›

The HENRY approach enables practitioners to create the conditions for change (parental confidence and desire to make changes) where parents can put the messages (information about nutrition, activity, etc) into practice as part of everyday life.

What are 3 most important treatments in a fracture? ›

splints – to stop movement of the broken limb. braces – to support the bone. plaster cast – to provide support and immobilise the bone.

What bone is the most painful to break? ›

The Femur is often put at the top of the most painful bones to break. Your Femur is the longest and strongest bone in your body, running from your hip to your knee. Given its importance, it's not surprising that breaking this bone is an incredibly painful experience, especially with the constant weight being put on it.

Which fracture is most damaging? ›

Comminuted fracture. Comminuted fractures are a more severe type of fracture, because your bone breaks into several pieces. You could have other damage with this type of fracture, due to the multiple bone shards.

Is Colles fracture volar or dorsal? ›

The term Colles fracture is often used eponymously for distal fractures with dorsal angulation. These distal radius fractures are often caused by falling on an outstretched hand with the wrist in dorsiflexion, causing tension on the volar aspect of the wrist, causing the fracture to extend dorsally.

Is Colles fracture volar displacement? ›

A Smith's fracture is a volar displacement fracture where the fragment of the radius that has broken off projects towards the palm side of the hand, while a Colles fracture results in dorsal displacement, causing the bone fragment to bend towards the back of the hand.

When should I start strengthening after a distal radius fracture? ›

You will start these exercises 5-7 days after surgery, at your first hand therapy visit. Do the wrist/forearm/thumb exercises 3x/day out of your splint. The finger exercises can be done in the splint, every 2 hours.

What is the most common method of reduction for a Colles fracture? ›

Surgical Procedures to Treat a Colles Fracture

Through surgery, either pins or a plate are used to hold the bone parts in place. Most fractures are aided in this way using locked Volar plating. This is a plate that offers increased amounts of stability.

Can a distal radius fracture heal in 4 weeks? ›

Most distal radius fractures take about three months or more to heal before you can return to all activities. Some residual soreness and stiffness may take up to one year or even more. Proximal radius fracture heals faster in around 6 to 12 weeks.


1. Volar (Henry) Approach to the Wrist .
(Orthopaedics & Trauma in Youtube)
2. orthohub surgical approaches: the volar approach to the distal radius–orthopaedic surgeons education
3. Radius Distal Volar Approach
4. Radius & Ulnar Shaft Fracture Approaches - Everything You Need To Know - Dr. Nabil Ebraheim
(nabil ebraheim)
5. Dorsal Approach and Plating of a Distal Radius Fracture
(David Tuckman, M.D.)
6. Extended FCR Approach EXPLAINED - w/ Dr. Orbay
(Nailed It Ortho Clips)
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