Minimally invasive anterior plate osteosynthesis of the distal radius: A 710 case-series

Abstract

IntroductionSince the 2000s, internal fixation of distal radius fracture by volar locking plate on an extended flexor carpi radialis (FCR) approach has become the gold standard. ObjectiveThe present study aimed to assess medium-term results of minimally invasive plate osteosynthesis (MIPO) in distal radius fracture. Material and methodsThe series comprised of 710 cases (512 female; mean age, 58 years). The 15mm approach was on the lateral edge of the FCR. The plate was slipped under the pronator quadratus. Closure used intradermal running suture without drain or orthosis. ResultsAt a mean 7 months’ follow-up, mean scar length was 17mm (range, 10–40mm), pain 1.13/10 (0–8), Quick-DASH 13.28 (0–86.36), and patient-rated wrist evaluation (PRWE) 11.48 (0–91). Compared to contralateral values, mean flexion was 87.23%, extension 88.52%, pronation 96.17%, supination 93.41%, and grip strength 79.68%. Hardware was removed in 45.92% of cases. There were 16 cases of secondary displacement, with 4 revision procedures, one of sepsis at 6 months, 10 of complex regional pain syndrome, and 14 of median nerve paresthesia, with 4 carpal tunnel release procedures. DiscussionThe minimally invasive FCR approach can be used for volar plate fixation of distal radial fracture. It has the advantage of conserving ligamentotaxis, facilitating reduction and improving scar esthetics. The incision can be extended if need be. Level of evidenceIII; single-centre retrospective study.