Il trattamento delle fratture distali del radio con placche e viti

Abstract

Internal fixation of distal radius fractures by fixed angle plates has two main advantages: a stable fixation of the fracture and the possibility to allow early motion. In most cases the plates are placed palmarly for three reasons: they don’t encumber if positioned correctly; the reduction of palmar fragments is, in most cases, much easier than that of dorsal fragments; and fixed angle screws maintain reduction if positioned in the subchondral bone. The palmar approach to the distal radius between the FCR tendon and the radial artery is described. Fracture fragments are reduced and the plate is positioned. Radioscopy helps to place the screws properly. Dorsal plates should be placed only in articular fractures without involvement of the palmar cortex or in complex intra-articular fractures associated to a palmar plate which screws are not able to fix the comminuted dorsal fragments. In order to approach the dorsal part of the radius, the third extensor compartment is opened and the floors of the second and fourth extensor compartment are raised. Fracture fragments are reduced and fixed definitely with one ore two low-profile plates.In case of a stable fixation, active motion of the wrist may start 10–15 days after the operation. Contraindications for plate fixation are severe osteoporosis, poor conditions of the patient and insufficient compliance. Technical errors like intra-articular placement of the screws may be prevented by the use of radioscopy. One should avoid the use of too-long screws, since they may cause the rupture of extensor tendons. The palmar plate should not be placed distally to the watershed line. Otherwise the rupture of the FPL tendon is possible.In conclusion, plate fixation of distal radius fractures is a reliable and modern method of treatment. Correct indications and techniques are essential to obtain good radiological and functional results.