What is the step-by-step procedure for Open Reduction Internal Fixation (ORIF) with plating of a fracture of the distal end of the radius?

From the Guidelines

Open reduction and internal fixation (ORIF) with plating is the recommended surgical procedure for treating distal radius fractures, as it allows for accurate restoration of radial length, inclination, and tilt, as well as realignment of articular fracture fragments 1. The procedure involves several key steps:

• The patient is positioned supine with the affected arm on a radiolucent table, and anesthesia is administered to ensure comfort and minimize pain.
• A volar (palm-side) approach is typically used, with an incision made through the flexor carpi radialis tendon sheath to access the fracture site.
• The pronator quadratus muscle is elevated from the radius to expose the fracture, and the surgeon reduces the fracture fragments to their anatomical position using direct visualization and fluoroscopic guidance 1.
• Temporary K-wires may be used to hold the reduction in place while preparing for definitive fixation with a pre-contoured volar locking plate.
• The plate is secured with screws, including locking screws in the distal fragment and cortical screws proximally, and the surgeon confirms proper reduction and hardware placement with fluoroscopy to avoid complications such as osteoarthritis 1.
• The pronator quadratus muscle is repaired over the plate when possible, and the surgical wound is closed in layers, followed by application of a sterile dressing and splint.
• Postoperatively, early finger motion is encouraged, with wrist motion typically beginning 1-2 weeks after surgery, and physical therapy plays a crucial role in restoring function and promoting full recovery 1. Key considerations for the procedure include:
• Restoration of radial length, inclination, and tilt to ensure proper alignment and stability of the wrist joint.
• Realignment of articular fracture fragments to minimize the risk of long-term complications such as osteoarthritis.
• Accurate placement of hardware to avoid penetration of the joint surface or excessive dorsal extension.
• Early mobilization and physical therapy to promote full recovery and restore function.

From the Research

Procedure Step by Step for Fracture Distal End Radius by ORIF with Plating

• The procedure for fracture distal end radius by Open Reduction and Internal Fixation (ORIF) with plating involves several steps:
  • Preoperative preparation: The patient is prepared for surgery, and the affected arm is cleaned and draped in a sterile manner 2.
  • Incision and exposure: A surgical incision is made on the volar (palmar) side of the wrist to expose the fractured distal radius 3, 4.
  • Reduction and fixation: The fractured bone is reduced, and a volar plate is used to fixate the fracture 3, 4.
  • Plate fixation: The plate is secured to the bone using screws, and the fracture is stabilized 3, 4.
  • Wound closure: The incision is closed, and the wound is dressed 2.

Key Considerations

• The choice of plate and fixation method depends on the fracture pattern and the surgeon's preference 3, 4.
• The use of a volar plate has been shown to provide better functional outcomes in the early postoperative period compared to other fixation methods 3, 4.
• Complications such as median nerve compression, tendon rupture, and arthrosis can occur, and patients should be monitored closely postoperatively 2.

Postoperative Care

• Patients should be encouraged to mobilize their wrist as soon as it is safe to do so to prevent stiffness 2.
• A rehabilitation program should be initiated to improve range of motion, strength, and function 3, 4.
• Follow-up appointments should be scheduled to monitor the patient's progress and remove any hardware as necessary 2.