AAHS ASPN ASRM - 2013 Annual Meeting - American Association ...

The Treatment of Unstable Distal Radius Fractures with the
DVR Plate and the Extended FCR Approach
Orbay J.L, Badia A., Indriago I., Khouri R.K., Gonzalez E., and Fernandez D.L.
Introduction: We present our clinical experience with a new internal fixation method for the general treatment of the
unstable distal radius fracture. The DVR plate applied through the extended FCR approach allows the volar management
of complex distal radius fractures regardless of their direction of instability. This technique provides stable internal fixation
and allows early function while avoiding the extensor tendon problems that have plagued dorsal plate fixation.
Methods: We treated unstable distal radius fractures, mostly dorsally displaced, through the extended FCR approach. This
is an extension of the classic FCR approach in which dorsal exposure is obtained by releasing the radial septum and mobilizing
the proximal radius. It provides sufficient exposure to manage articular displacement, apply bone graft and treat nascent
malunions. Internal fixation was provided by the DVR plate, which is a fixed angle device, designed for volar fixation
of dorsally unstable distal radius fractures.
Results: We followed 127 patients presenting with 136 unstable distal radius fractures for an average of 27 weeks. All
cases were treated with the DVR plate through the extended FCR approach. The fractures were classified according to the
“Comprehensive Classification of Long Bone Fractures” and to the direction of instability. The clinical results were evaluated
radiographically and functionally. The average final range of motion was 60 deg. of dorsiflexion, 58 deg. of volar flexion,
82 deg. of pronation and 79 deg. of supination. The grip strength was 77% of the contralateral side. No external fixation
was needed. Functional use of the hand was allowed on the first post-op week. Splinting was utilized for four weeks.
There were no cases of plate failure or loss of reduction. Complications consisted of one case of dorsal tendon irritation
from an excessive long peg, treated by hardware removal and two cases of transient regional pain syndrome.
Conclusion: The general treatment of unstable distal radius fractures with internal fixation and early function is possible
with the use of the DVR plate and the extended FCR approach. This technique presents a low complication rate and minimizes
tendon problems.
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