Wrist Fractures: Open Plate Fixation of Distal Radius Fractures

Wrist Fractures: Open Plate Fixation of Distal Radius Fractures

On this cadaveric left hand, an incision line is marked by the surgeon. The skin is cut about 3 to 4 inches in length. The purpose of this cut will be to dissect past all soft tissues to get down to the fractured bone site of the distal radius.

The tissue under the skin is carefully separated to avoid injury to ligaments, blood vessels, and small nerve branches. The tendons seen here are very stout structures, so metal retractors are placed between them to pull away and protect soft tissues like these flexor muscles.

This next layer seen here is a muscle called the pronator quadratus or the PQ. Underneath here we will find the floor of the wrist, the radius bone. The PQ is cut, scraped back from the radius bone and is usually excised entirely.

The tendons seen here are freed up from their insertion points on the thumb side of the wrist to release tension and deforming forces on any fragments in the area. Please note that this cadaver specimen is fully intact and does not have a fracture. This line indicates where the commonly occurring Colles fracture may arise.

The remaining PQ is peeled and scraped further back. This surgeon prefers to use a lobster claw clamp to center and approximate the initial placement of the volar plate that will be fixed onto the bone. The dissection to the fracture site is ready for placement of the plate.

The surgeon secures an aiming guide onto the volar plate. This will help the angles of the drilling for the screws that will be placed into the plate later. This aiming guide will be removed before the procedure is finished.

The plate with the aiming guide is now centered on the radius and the drill makes way for the first screw. The placement is checked on x-ray, and alignment of the plate looks good. A metal wire is placed onto the end of the plate so it does not move as the rest of the holes are drilled for the remainder of the screws.

This metal wire is also checked so that it does not pierce the joint. If this is correct, as it is shown here, none of the screws will pierce the joint either. The black drop-in guide helps with drilling and measuring the length of screw needed for that particular spot.

The screw is placed on a screwdriver by the surgical assistant and handed to the surgeon for insertion. X-ray checks that it is in the correct drilled angle. The next screw seen here is a locking peg. This type acts as a scaffold to hold the distal radius fragment in an aligned position. It also locks into the plate.

The rest of the holes are drilled and filled with appropriate screws. On this particular plate, the middle screws are a bit larger than the end screws. This provides stable fixation onto the radius. X-ray checks the final placement of all the screws.

After this, the retractors are removed, the skin is sewn shut, and a cast or splint is added for the duration of the healing. Further treatment protocol, such as physical therapy, will be relayed between the surgeon and patient.