OPEN REDUCTION AND PLATE OSTEOSYNTHESIS IN INTRAARTICULAR FRACTURES OF THE DISTAL RADIUS - INDICATIONS AND OPERATIVE TECHNIQUE

In the past few years we have seen vast changes in both the assessment and the management of fractures of the distal radius. This is attributable to several factors. On the one hand, conservative treatment has show poor results in a considerable number of patients, and on the other hand, more and more young patients are presenting with this common lesion. Furthermore, the spread of new methods of osteosynthesis and of modern materials, such as implants, etc., have greatly improved the results of operative procedures, even in complicated fractures of the radius. Therefore, in certain types of fractures far better functional results can be achieved by open reduction. Particularly in intra-articular fractures of the distal radius with or without compression zones and/or injury to the ligaments closed manipulation and subsequent immobilization by plaster is only partially successful. To achieve successful repair of the complex mechanisms in the wrist and the distal radio-ulnar jacket (DRU) joint, these fractures mostly require open reduction and plate fixation including additional support for the articular surface by a cortico-cancellous bone graft from the iliac crest. This enhances the stability of the reduced fragments and facilitates early mobilization which, in turn, greatly improves the functional results. In palmar displaced fractures a palmar approach is employed for both surgical repair and plate fixation, while dorsal compression fractures are reduced, filled and stabilized using a dorsal approach. In this study a special operative procedure for intra-articular comminuted fractures is described. A palmar approach is employed for fracture reduction, while the compression zone is filled by bone graft via an additional dorsal incision. For osteosynthesis the palmar approach is preferable in a majority of these cases. In conclusion the results Of this operative technique are reported.