Extra-articular Distal Radial Fractures Research Articles

Anterior locking plate fixation versus cast immobilization for acceptably reduced extra- articular distal radial fractures: long-term follow-up of a randomized controlled trial.

This study reports the long-term results of a randomized controlled trial comparing anterior locking plate fixation with cast immobilization for extra-articular distal radial fractures. After 5.3 years of follow-up, no clinically relevant functional differences were found.

Is antegrade K-wire pinning better than retrograde pinning for distal radius fracture? A comparative study

<p class="abstract"><strong>Background:</strong> The treatment of distal end radius has undergone tremendous changes over the years due to better understanding of the fracture anatomy, mechanism of injury and development of newer techniques and implants. The objective of treatment of distal end radius fracture is to restore the anatomy and to obtain early function. Percutaneous pinning is a minimally invasive technique to maintain the reduction and prevent re-displacement of the fracture fragments. Sato et al. introduced a technique of fixation for the unstable extra-articular distal radial fractures by manual reduction and antegrade intra-medullary pinning.</p><p class="abstract"><strong>Methods:</strong> A retrospective study with a sample size of 30, where 15 of the selected patients had undergone antegrade fixation and the rest 15 had undergone retrograde fixation.<strong></strong></p><p class="abstract"><strong>Results:</strong> Patients were evaluated for functional and radiological outcomes after a mean follow up of one year. No statistically significant difference was found between the two methods.</p><p class="abstract"><strong>Conclusions:</strong> Both the procedures were effective in managing the distal radius fracture with preservation of fracture hematoma. However soft tissue complications were less in antegrade pinning as compared to retrograde.</p><p class="abstract"> </p>

Comparison of functional outcomes for displaced extra-articular distal radius fractures managed by operative and non-operative methods: A prospective cohort study

: Fractures of the distal radius are one of the most common injuries seen in our day-to-day practice. It accounts for almost 4% of the injuries seen in the emergency department. Despite its high incidence and the substantial possible implications of suboptimal management, no high-level evidence regarding the best treatment method yet exists. The study aimed to compare the functional outcomes of extra articular distal radius fractures managed operatively with those managed conservatively. In this prospective cohort study conducted between November 2018 to September 2020, 18 to 65 years old patients with displaced extraarticular distal radial fracture were treated surgically or conservatively. DASH and Modified Mayo Wrist Score were calculated after a follow up of one year.: At the end of 12 months the patients were evaluated, and it was noticed that patients who were treated operatively had significantly better functional and clinical outcomes, as indicated by significantly higher Mayo scores than patients treated conservatively by casting (all p values < 0.05). The DASH scores were lower in the patients who had undergone operative management. Patients treated with volar plate fixation were able to resume activities of daily living few weeks earlier compared to those managed with K-wire fixation and conservative group. Therefore, we can conclude that volar plate fixation gives significantly better clinical and functional results than other methods of treatment.

What's New in Orthopaedic Trauma.

What's New in Orthopaedic Trauma.

Prolonged Operative Time Associated with Increased Healthcare Utilization after Open Reduction and Internal Fixation of Intra-Articular and Extra-Articular Distal Radial Fractures: An Analysis of 17,482 Cases.

Background The current literature does not contain a quantitative description of the associations between operative time and adverse outcomes after open reduction and internal fixation (ORIF) of distal radial fractures (DRF). Questions/Purpose We aimed to quantify associations between DRF ORIF operative time and 1) 30-day postoperative health care utilization and 2) the incidence of local wound complications. Methods The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was queried for DRF ORIF cases (January 2012-December 2018). A total of 17,482 cases were identified. Primary outcomes included health care utilization (length of stay [LOS], discharge dispositions, 30-day readmissions, and reoperations) per operative-time category. Secondary outcome was incidence of wound complications per operative-time category. Multivariate regression was conducted to determine operative-time categories associated with increased risk while adjusting for demographics, comorbidities, and fracture type. Spline regression models were constructed to visualize associations. Results The 121 to 140-minute category was associated with significantly higher risk of a LOS > 2 days (odds ration [OR]: 1.64; 95% confidence interval [CI]:1.1-2.45; p = 0.014) and nonhome discharge (OR: 1.72; 95% CI:1.09-2.72; p = 0.02) versus 41 to 60-minute category. The ≥ 180-minute category exhibited highest odds of LOS > 2 days (OR: 2.08; 95%CI: 1.33-3.26; p = 0.001), nonhome discharge disposition (OR: 1.87; 95% CI: 1.05-3.33; p = 0.035), and 30-day reoperation occurrence (OR: 3.52; 95% CI: 1.59-7.79; p = 0.002). There was no association between operative time and 30-day readmission ( p > 0.05 each). Higher odds of any-wound complication was first detected at 81 to 100-minute category (OR: 3.02; 95% CI: 1.08-8.4; p = 0.035) and peaked ≥ 181 minutes (OR: 9.62; 95% CI: 2.57-36.0; p = 0.001). Spline regression demonstrated no increase in risk of adverse outcomes if operative times were 50 minutes or less. Conclusion Our findings demonstrate that prolonged operative time is correlated with increased odds of health care utilization and wound complications after DRF ORIF. Operative times greater than 60 minutes seem to carry higher odds of postoperative complications.

206 Audit of Time to Surgical Fixation of Distal Radial Fractures Compared to British Orthopaedic Association Standard for Trauma (BOAST) Guidelines at Busy District General Hospital

Abstract Aim BOAST guidelines state that intra-articular distal radial fractures should be operated on within 72 hours of injury and extra-articular distal radial fractures which require surgical management should be operated on within 7 days. The aim of this audit was to see how the orthopaedic department at a busy district general hospital compared to these guidelines. Method Retrospectively looked at operations carried out over a 10-month period. All Manipulation Under Anaesthesia, K wire and Open Reduction Internal Fixations of distal radial fractures were included. Results Over the 10-month period, 49 intra-articular and 60 extra-articular fractures were operated on. 65% of intra-articular fractures were fixed within 72 hours and 82% of extra-articular fractures were fixed within one week. Mean time from date of injury to operation was 3.88 days for intra-articular and 2.98 days for extra-articular fractures. Mean time from decision of surgery to operation was 2.32 days for intra-articular and 2.18 days for extra-articular fractures. Conclusions Clearly, the management of extra-articular fractures is closer to the standards set by BOAST guidelines. It can be difficult to establish from an x-ray whether a fracture is extending into a joint surface - this can delay the fracture clinic appointment and the operation. The difference between the mean time of injury to operation and mean time of decision of surgery to operation for intra-articular fractures show that once the decision to operate has been made, it is carried out quickly. Educating A+E and orthopaedic staff on recognising intra-articular fractures could expedite the time to surgery.

Loss of radial height in extra-articular distal radial fracture following volar locking plate fixation

BackgroundRadial height is an important prognostic factor in treating distal radius fracture. However, does further collapse of radial height in distal radius fractures after with volar locking plate fixation have a great impact on the prognosis? The present study aimed to elucidate radial height loss and determine the associated risk factors after open reduction and internal fixation with volar locking plate in patients with extra-articular distal radius fractures. HypothesisPatients with radial height collapse after fracture reduction and internal fixation with a volar locking plate may have poor outcomes. MethodsData of 87 patients (21 male) undergoing surgery for acute extra-articular distal radius fractures (AO: 23-A2 or 23-A3) between February 2014 and July 2016 were evaluated retrospectively. Patients were divided into two groups by radial height loss. Potential risk factors were tested by Pearson correlation coefficients. Stepwise multiple regression logistic analysis determined significant independent risk factors for extra-articular distal radius fractures. Clinical evaluation was performed by the same surgeon by determining wrist ROM. Grip strength was measured with a Jamar dynamometer and compared with non-affect wrist in percentage. In addition, all the patients were asked to grade modified Mayo wrist score and Visual Analogue Scale (VAS) score. These findings were recorded postoperative 1 year of follow-up. ResultsMean radial height loss was 1.3±0.9mm. Age (ß=0.002, p=0.003), postoperative ulnar-positive deformity (ß=0.107, p<0.001), DEXA (ß=−0.015, p=0.008), and shortest diameter of distal fracture fragment in AP and lateral views (ß=−0.050, p=0.037; ß=−0.080, p=0.043) were significantly associated with radial height loss. As for the outcome of clinical prognosis, though radial height collapse group had poorer wrist range of motion, there was no statistical difference. Besides, there were no significant differences in grips strength and VAS score between these two groups. However, in regards of modified Mayo wrist score, the percentage of patients with poor outcomes is significant higher in radial height collapse group (p=0.039). Moreover, all patients with poor outcomes in radial height collapse groups were older than 65-year-old. DiscussionRadial height loss is noted in patients undergoing open reduction and internal fixation with volar locking plate for extra-articular distal radius fractures. Risk factors for radial height collapse include advanced age, poor bone quality, shortest distance between fracture site and articular surface and postoperative ulnar-positive deformity. Level of evidenceIV; non-comparative prospective study.

Functional outcome of intra-articular fracture of distal end of radius treated by open reduction and internal fixation with locking distal radius system

Background: There is alays been a dilemma in the treatment of intra-articular distal radius fracture (DRF). Close reduction and cast application gives satisfactory result in extra-articular Distal Radial Fractures but there is alays been debate beteen open and close reduction in the intra-articular fracture. Hence, this study is to evaluate effectiveness of open reduction and internal fixation of intra-articular Distal Radial Fractures. Materials and Methods: This prospective observational study as carried out in the department of orthopedics, All India Institute of Medical Sciences, Patna, from August 2016 to March 2019. The patient ere included ho qualified the inclusion criteria. The included patient ere treated by open reduction and internal fixation ith distal radius plate. The outcome as assessed in term of anatomical variables (radial dorsal tilt, length, and angle), residual deformity, and subjective result evaluation using Sarmiento's modification of Lind Storm criteria. The complication if any as also noted. Results: This study included 30 cases of intra-articular DRF, 12 fractures of AO type B, and 18 fractures of AO type C. Anatomically, 24 patients (80%) had excellent restoration of anatomy, 4 patients (13%) had good restoration and 2 had fair (7%) restoration of anatomy. 93% of patients had excellent to good alignment of fragments and good reduction could not be achieved in 7% of patients resulting in fair or poor results. Functionally, 22 patients (73%) had excellent, 5 good (17%), and 3 patients had fair (10%) restoration of functions. Conclusion: Open reduction and internal fixation ith volar plate and scres fixation gives satisfactory (good to excellent) result in intra-articular Distal Radial Fractures.

Surgical Treatment of Distal Radial Fractures with External Fixation Versus Volar Locking Plate: A Multicenter Randomized Controlled Trial.

The use of volar locking plate fixation (VLP) for unstable extra-articular distal radial fractures has increased in the last decades. External fixation (EF) is less frequently used. This change of surgical approach has only to some extent been evidence-based. In this multicenter, randomized controlled trial, we compared VLP and EF in patients between 18 and 70 years of age who had a displaced extra-articular distal radial fracture (OTA/AO type A3). The patients were examined at 6 weeks, 3 months, and 1 year postoperatively. The primary outcome measure was the Patient-Rated Wrist/Hand Evaluation score (PRWHE). Secondary outcomes were the shortened version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH), pain score on a visual analog scale (VAS), and radiographic measurements. Range of motion, grip strength, finger stiffness, complications, and reoperations were also recorded. One hundred and fifty-six patients were included. One hundred and forty-two (91%)-127 women (89%) and 15 men (11%)-completed 1 year of follow-up. Sixty-nine patients were treated with VLP and 73, with EF. The mean age was 56 years. At 6 weeks, the median PRWHE score was significantly higher in the EF group (44) compared with the VLP group (27) (p < 0.001). At 3 months and 1 year, the difference between groups was not significant. The median QuickDASH score was 27 in the VLP group and 43 in the EF group at 6 weeks (p < 0.001), and a significant difference persisted at 3 months (p = 0.023). The VLP group had superior results in terms pain during activity, wrist extension, and ulnar and radial deviation at 1 year, whereas the number of major complications was similar in the 2 groups. Patients treated with VLP had earlier recovery of function compared with patients treated with EF. One year postoperatively, we found no significant functional difference. Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Infection after buried or exposed K-wire fixation of distal radial fractures: a randomized clinical trial.

We treated 220 extra-articular distal radial fractures with closed reduction and percutaneous K-wire fixation and randomized K-wire placement to buried or exposed. We analysed the incidence and severity of infection and the mobility of the metacarpophalangeal joints. At 6weeks postoperatively, 12 patients in the exposed group had infections versus two in the buried group, which was a statistically significant difference. Mobility was statistically but not clinically better in the buried group. One patient in each group had wires removed before fracture healing due to infection, which resulted in malunion. From this study we conclude that, in the treatment of distal radial fractures, it is better to bury the K-wires under the skin, especially when geographical conditions make it difficult to control the patients' adherence to hygiene and postoperative care despite the higher costs incurred with removal of buried K-wires.Level of evidence: II.

Early Mobilization and Physiotherapy Vs. Late Mobilization and Home Exercises After ORIF of Distal Radial Fractures: A Randomized Controlled Trial.

Background:Volar locking plates have permitted early mobilization, omitting the need for prolonged cast immobilization, after distal radial fractures (DRFs). However, the type of rehabilitation following plate fixation of DRFs remains an unresolved issue. The purpose of this study was to evaluate the effect of physiotherapy after volar plate fixation of DRFs. At a 2-year follow-up, we compared the results of immediate physiotherapy (early mobilization) with those of home exercises following 2 weeks in a dorsal plaster splint (late mobilization).Methods:Patients with an extra-articular DRF scheduled for open reduction and internal fixation (ORIF) with a volar locking plate were evaluated for eligibility for enrollment in the study. The patients were randomized into 2 groups: (1) early mobilization and physiotherapy and (1) late mobilization and home exercise. In the early mobilization group, the plaster splint was removed after 2 to 3 days. During the first 3 months, the patients met with the institution’s physiotherapist every other week. The late mobilization group wore the dorsal splint for 2 weeks and only met with our physiotherapist once, when the splint was removed. This group was provided with a home physiotherapy program and instructed to perform home exercises on their own.Results:One hundred and nineteen patients were included in the study. The 2 groups had similar demographics with respect to age, sex, and baseline values. Seven patients were lost to follow-up. No clinically relevant difference in scores on the shortened version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire was found between the 2 groups at any of the follow-up evaluations. The largest difference in the QuickDASH score was found at 6 weeks, when the early mobilization group had a mean score of 30 compared with a mean of 37 in the late mobilization group (p = 0.05).Conclusions:Early mobilization and multiple physiotherapy visits did not improve wrist function compared with standard treatment of 2 weeks in a dorsal plaster splint, a single physiotherapy visit, and home exercises. Early mobilization following ORIF of an extra-articular DRF is safe.Level of Evidence:Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Pharmacokinetic modeling of multislice dynamic contrast-enhanced MRI in normal-healing radial fractures: A pilot study.

To define the range of quantitative pharmacokinetic parameters in normal-healing bone with dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). DCE-MRI is an established technique for characterizing abnormal tissue microvasculature within solid tumors, but has also shown promise for assessing bone and bone marrow. In this study ethical approval for eight patients was obtained. Inclusion criteria were an extra-articular distal radial fracture in patients aged 20-50 years which had united by 6 weeks in plaster cast. This was assessed by an experienced orthopedic surgeon. DCE-MRI was performed at 1.5T 6 weeks after initial injury. The transfer constant (K(trans) ), transfer rate (Kep ), and initial area under the curve (IAUC) values for the fracture site and adjacent marrow were obtained for each patient. The mean T1 , K(trans) , Kep , and IAUC at the fracture site were 1713 (standard deviation [SD] 645), 0.09 (SD 0.07), 0.17 (SD 0.17) and 4.9 (SD 4.4). The relative standard deviation (RSD) for the fracture site ranged from 0.38 to 0.97 and for the adjacent marrow ranged from 0.95-3.88. Within each patient the range of RSDs was 0.04-0.42 for T1 , 0.26-0.91 for K(trans) , 0.14-1.06 for Kep , and 0.35-0.96 for the IAUC. Pharmacokinetic measures of perfusion can be obtained from healing fractures using DCE-MRI with "excellent" intraclass correlation coefficients for inter- and intrarater reliability. The use of these perfusion parameters is limited by wide patient-to-patient variation and slice-to-slice variation within patients.

The clinical outcome after extra-articular colles fractures with simultaneous moderate scapholunate dissociation.

Background An increased scapholunate gap is sometimes seen in patients with a distal radial fracture. The question remains as to whether this represents a scapholunate ligament injury that requires treatment. Questions/purposes We wished to examine the natural history of an increased scapholunate gap in patients following an extra-articular distal radial fracture. Patients and Methods We reviewed 260 patients who had sustained a distal radial fracture at a mean of 6.2 (2.7-11.9) years previously and identified 12 extra-articular fractures with an increased gap between the lunate and scaphoid. The mean scapholunate gap was 2.6 (2.1-3.4) mm, and the mean scapholunate angle 62° (39°-90°). Controls were found among the remaining patients with extra-articular fractures. Selection criteria were same sex, age at fracture within 5 years, time between injury and review within 2 years, ulnar variance within 2 mm, and dorsal angulation within 5° of index patient. When more than one control fulfilled the criteria for an index patient, their values were averaged. In total there were 54 controls for the 12 index patients. Results The mean difference between index patients and controls in wrist range of motion was 4%, in grip strength 5%, in visual analog scale (VAS) for pain 1 (on a scale from 1 to 100), in Quick-DASH (Disability of the Arm, Shoulder, and Hand) score 5, and in PRWE score 1. The study was calculated to have the power to detect a difference in Quick-DASH scores and in Patient-Rated Wrist Evaluation (PRWE) scores of 14. Conclusions We conclude that at a mean follow up of 6.2 years following an extra-articular distal radial fracture, no surgical treatment is usually needed with a scapholunate gap of between 2.1-3.4 mm. Level of Evidence III, Case control study.

Radiological criteria for acceptable reduction of extra-articular distal radial fractures are not predictive for patient-reported functional outcome

The purpose of this study was to assess the association between arm-specific disability measured with the QuickDASH questionaire and radiological criteria in patients with extra-articular distal radial fractures. A consecutive series of 385 patients were initially treated non-operatively for an extra-articular distal radial fracture and 257 (69 %) patients were included in the study. In 203 of these patients (78%) the quality of radiographic reduction was judged to be adequate by radiological parameters, which included dorsal tilt, radial inclination, and radial shortening. In 54 patients (22%) the quality of radiographic alignment was judged to be inadequate. We observed no effect of radiographic parameters on the functional outcome. Female sex and longer duration of follow-up (>35 months) were the only independent prognostic factors significantly associated with a worse QuickDASH score.

Comparison of Intra-Articular Simple Compression and Extra-Articular Distal Radial Fractures

The impact of a single well-reduced or stable intra-articular fracture oriented in the sagittal plane on the outcome of internal fixation of a distal radial fracture is uncertain. We tested the hypothesis that wrist motion and function scores would not differ between patients with an extra-articular fracture and those with a single sagittal intra-articular fracture following open fracture reduction and internal fixation with use of a volar locking plate. Thirty-seven patients with a single sagittal intra-articular fracture of the distal aspect of the radius and seventy-four age and sex-matched patients with an extra-articular distal radial fracture were retrospectively analyzed with use of data gathered in a cohort study of plate and screw fixation of distal radial fractures. A volar locking plate was used in all patients. The two cohorts were analyzed for differences in motion, grip strength, pain, and Gartland and Werley, DASH (Disabilities of the Arm, Shoulder and Hand), and SF-36 (Short Form-36) scores six, twelve, and twenty-four months after surgery. Differences between the cohorts and differences within each cohort over time were determined with use of regression analysis and the likelihood ratio test. Patients with a single sagittal intra-articular fracture and those an extra-articular fracture did not differ significantly with respect to motion, grip strength, Gartland and Werley score, or DASH score at any time point. However, there was a trend toward less pronation (95% compared with 98% of that in the contralateral arm) and less grip strength (76% compared with 81% of that in the contralateral arm) at six months and toward a smaller flexion-extension arc (118° compared with 128°) at one year after surgery in patients with a single sagittal intra-articular fracture. Open reduction and volar locking plate and screw fixation of extra-articular fractures and of simple intra-articular fractures of the distal aspect of the radius are associated with comparable impairment and disability within two years of surgery.

Three-point index in predicting redisplacement of extra-articular distal radial fractures in adults

Three-point index in predicting redisplacement of extra-articular distal radial fractures in adults

Should unstable extra-articular distal radial fractures be treated with fixed-angle volar-locked plates or percutaneous Kirschner wires? A prospective randomised controlled trial

Should unstable extra-articular distal radial fractures be treated with fixed-angle volar-locked plates or percutaneous Kirschner wires? A prospective randomised controlled trial

Should unstable extra-articular distal radial fractures be treated with fixed-angle volar-locked plates or percutaneous Kirschner wires? A prospective randomised controlled trial

Fractures of the distal radius are commonly treated with cast immobilisation; however, those potentially unstable injuries with dorsal comminution may need operative intervention. This intervention is usually with manipulation and Kirschner wires but advances in locking-plate technology have enabled surgeons to achieve anatomical reconstruction of complex fracture patterns, even in poor-quality osteoporotic bone. To ascertain if fixed-angle volar-locked plates confer a significant benefit over manipulation and Kirschner-wire stabilisation, we prospectively randomised 56 adult patients with isolated, closed, unilateral, unstable extra-articular fractures into two treatment groups, one fixed with K-wires and the other fixed with a volar locking plate. Functional outcomes were assessed using Gartland and Werley and Disabilities of the Arm, Shoulder and Hand (DASH) scores. These were statistically better in the plate group at 3 and 6 months. Radiological assessment showed statistically better results at 6 weeks, 3 months and 6 months, post-operatively. In the plate group, there was no significant loss of fracture reduction.

Three-point index in predicting redisplacement of extra-articular distal radial fractures in adults

Introduction In distal radial fractures in adults, factors affecting instability have been investigated in many studies in an effort to shorten the preoperative waiting period for the fractures requiring surgery. Numerous factors, aside from the alignment-related indices, have been searched to predict redisplacement. Unlike as in paediatric counterparts, the casting technique and casting-related indices have not been appropriately considered in adults. The aim of this study was to determine the impact of the various previously investigated factors in addition to casting technique-related indices such as three-point index, cast index, padding index and gap index, in predicting the risk of redisplacement of extra-articular distal radial fractures in adults and the presence of the ulnar deviation of the cast. Patients and methods Seventy-five patients over 18 years who were treated with a cast in our emergency department within 24 h after a displaced distal radial fracture, were recruited into the study. Age, alignment-related indices, cast-related indices, extent of the ulnar deviation of the cast, having a non-anatomical reduction, co-existing ulnar fracture, dorsal comminution and obliquity of the fracture line were investigated. Casting technique according to three-point index, obliquity of the fracture line, degree of the ulnar deviation of the cast, and reduction accuracy were the significant factors affecting redisplacement. Results The three-point index had a sensitivity of 95.8%, specificity of 96.1%, positive predictive value of 92%, and negative predictive value of 98% in predicting redisplacement. Logistic regression revealed that having an inadequate cast according to the three-point index ( p < 0.001), degree of obliquity of the fracture line ( p = 0.018), decreased ulnar deviation of the cast ( p = 0.002), and having a non-anatomical reduction ( p = 0.029) were the significant predictive factors in redisplacement. Conclusions Our results suggest that the casting technique plays a major role in the success of conservative treatment, which can best be examined with the three-point index. Ulnar deviation of the cast and fracture obliquity are the other dominant factors affecting redisplacement.

Displaced Distal Radial Fractures Treated Using Volar Locking Plates: Maintenance of Normal Anatomy

The objective is to assess the ability of volar locking plates to maintain fracture reduction when used to treat dorsally displaced extra- and intra-articular distal radial fractures. This prospective study was conducted over an 12-month period. Consenting patients who had sustained a closed, dorsally displaced distal radial fracture, treated by open reduction and internal fixation using a volar distal radial locking plate were included in the study. Radial inclination, volar tilt, and ulnar variance were measured from radiographs taken at least 3 months after surgery and compared with radiographs of the uninjured side. Only two of the eight participating surgeons have a specialist interest in upper limb surgery. Thirty-three patients were included in the study. There were 23 women and 10 men. The mean age was 49.5 years (range, 26-82 years). According to the Orthopaedic Trauma Association (OTA) classification, there were 19 Type A, 1 Type B, and 13 Type C fractures. The average restoration of volar tilt was 1-degree angle of under correction with a range of 7.3-degree angle of under correction to 3.7-degree angle of over correction, when compared with the uninjured side. The mean restoration of radial inclination was 1.9-degree angle of under correction with a range of 10-degree angle of under correction to 8.4-degree angle of over correction. As a group, the mean ulnar variance was 0 mm with a range of 2 mm of relative ulnar shortening to 3.5 mm of ulnar prominence when compared with the uninjured side. In the hands of general trauma surgeons, the volar approach combined with the application of a suitable volar locking plate is a good treatment for restoring and maintaining the anatomy of dorsally displaced intra- and extra-articular distal radial fractures.