OPEN REDUCTION AND INTERNAL FIXATION (ORIF) FOR DISTAL RADIUS FRACTURES: VOLAR APPROACH

Indications

• Displaced, irreducible extra-articular fractures (A3).

• Unstable, partial intra-articular fractures (B1, B2, B3), or complete (C2, C3).

• Fractures requiring bone grafting.

• Palmarly displaced short oblique fractures.

• Volar Barton's.

• Fractures with primary instability.

Pre-operative planning

Clinical assessment

• Mechanism of injury: grading from low- to highvelocity trauma.

• Typical deformity, swelling, tenderness.

• Evaluate neurovascular status of the hand.

• Assess soft tissue damage.

• Evaluate patient for age, hand dominance, occupation, and level of activity.

• Check for associated ligamentous lesions of fractures of carpal bones.

Radiological assessment

• High-quality anteroposterior and lateral radiographs (Fig. 4.37a,b).

• Oblique films (45? pronated and supinated).

• Assess degree of fragment displacement, quality of bone, whether the fracture is intra-articular or extraarticular, direction of displacement,metaphysealcomminution.

• CT scan if the diagnosis is not clear in plain radiographs.

Timing of surgery

• Immediatelywhenthefractureisopenorprimarycompression of the median nerve is present.

• After 5-6 days if there is important soft tissue swelling (after reduction of the initial displacement and immobilization in a plaster splint).

Operative treatment

Anaesthesia

• At induction, administration of prophylactic antibiotics as per local hospital protocol.

• General anaesthesia is preferable. Avoid a regional anaesthetic/block in acute injuries as it masks symptoms indicating compartment syndrome in the immediate post-operative period.

• Apply a tourniquet to the upper armif not contraindicated (situations in which the soft tissue envelope is extremely traumatized).

Table and equipment

• AOsmall-fragmentset 3.5mmor Jupiter plating system (Fig. 4.38).

• Standard osteosynthesis set as per local hospital protocol.

• Fluoroscopy is necessary for intraoperative imaging.