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Volar Plating of Distal Radius Fractures

Distal radius fractures are very common particularly in elderly ladies. Most of them are of the Colles type and result from a fall on the outstretched hand. There is a tendency now to treat these fractures more and more by operation. This can be pinning with 3 or so wires or plating. Plating gives a more solid and stable fix.

ANAESTHETIC

General or regional anaesthetic.

OPERATIVE PROCEDURE

A 5-7cm cut is made along the thumb side of the front (palmar) of the wrist.

Tendons are retracted and a muscle cut that lies at the front of the radius is cut to expose the fracture. With an X-ray machine in the operating theatre, a plate is applied to the distal fragment (the part of the fracture nearest the wrist) using screws or pins. The plate is then levered down onto the proximal fragment (the part of the bone nearest the arm) and fixed to that using more screws.


POST OPERATIVELY

The wrist is elevated overnight, antibiotics are given to prevent infection and a cast is worn for 2 weeks. At 2 weeks the cast and stitches are removed and the patient is sent for physiotherapy. Time off work 6 - 8 weeks.

COMPLICATIONS

  1. Infection - this is incredibly rare at 1 - 2% and in fact Mr Field has not seen it but it is feasible if one is inserting something from outside of the joint into the joint then one can introduce infection into the joint at that stage.
  2. Tendon damage - 1%
  3. Nerve damage - 0.5%
  4. Complex regional pain syndrome