Wrist Fractures: Fixation With a Wrist Hook Plate

Wrist Fractures: Fixation With a Wrist Hook Plate

This video will provide a surgical treatment demonstration of a wrist fracture utilizing a hook plate. The procedure will be demonstrated on a cadaveric specimen. The wrist joint comprises the ends of 2 bones in the forearm, called the radius and ulna, and a row of small bones called carpal bones. Wrist fractures most commonly impact the end of the radius and are referred to as distal radius fractures.

When the thin edge of the palm side of the radius is injured, it is essential to ensure the small fragment of bone is stabilized well to prevent later complications in the joint. An implant called a hook plate can be used in this circumstance. Here is a right hand. An incision will be made along the palm side of the wrist. Here is the exposed radius. A surgical retractor will hold the soft tissues out of the surgical field.

A temporary wire will be inserted to hold the presumed fracture fragment in alignment. An x-ray is taken to confirm the placement of the wire into the edge of the radius bone, holding the fractured bone in place. There is no fracture seen on this x-ray given the cadaver's normal anatomy. The surgeon will use a plate guide as a template to drill holes in the bone before placing the plate. Holes will be drilled through the cannulas in the guide. The guide is removed, and the surgeon marks the holes with a surgical pen.

The actual plate is then introduced. The surgeon will align the tines, or prongs, with the recently drilled holes in the bone. Light pressure will be used to engage the prongs with the holes. A drill and drill guide will be used to make a path for an incoming screw using the oblong hole in the plate. The hole will be measured, and the proper-sized screw will be inserted. The temporary wire will then be removed. An x-ray is shown with the plate in proper alignment.

The surgeon is shown drilling another hole in preparation for the placement of a locking screw. These screws have threads that engage with the threads in the plate, which provides more stability, preventing movement. The locking screw is placed at an angle to provide additional support to the presumed fracture fragment at the edge of the radius. An additional x-ray is taken to confirm the placement of the supporting locking screw. The remaining locking screws are placed similarly. The incision will be closed, and the surgery is now complete.