From the Research
During a distal radius fracture ORIF, the surgeon must carefully identify and protect several key anatomical structures, including the flexor carpi radialis tendon, radial artery, pronator quadratus muscle, median nerve, superficial branch of the radial nerve, flexor tendons, extensor tendons, and the distal radioulnar joint, as highlighted in a study published in the Journal of wrist surgery 1. The most recent and highest quality study on this topic is from 2024, which presents a technique for minimally invasive arthroscopic-assisted reduction and percutaneous screw fixation with an extremity traction device 2. However, the key structures to be observed during dissection for a distal radius fracture ORIF are:
- The skin and subcutaneous tissue, which are navigated through using either a volar (Henry) approach or a dorsal approach depending on the fracture pattern
- The flexor carpi radialis tendon, which serves as an important landmark in the volar approach
- The radial artery, which must be protected throughout the procedure
- The pronator quadratus muscle, which is identified and elevated from the radius to expose the fracture site
- The median nerve, which lies ulnar to the surgical field but can be at risk
- The superficial branch of the radial nerve, which must be protected when using certain approaches
- The flexor tendons and extensor tendons, which must be identified and protected to prevent complications such as tendon irritation or rupture
- The distal radioulnar joint, which must be preserved to maintain proper wrist function. A study published in the British journal of hospital medicine provides an evidence-based approach to assessment and management of distal radius fractures, emphasizing the importance of careful evaluation and management to prevent complications 3. Another study published in the Journal of wrist surgery evaluated the frequency of flexor pollicis longus tendon rupture after volar plate fixation of distal radius fractures and identified factors that contribute to this complication 1. Additionally, a study published in Injury investigated the possible relation between parameters measured on post-operative radiographs and the occurrence of flexor pollicis longus ruptures, highlighting the importance of careful plate placement and fracture reduction 4. A review of surgical exposures for distal radius fractures published in Hand surgery & rehabilitation discusses the various approaches that can be used for ORIF of distal radius fractures and the specific indications for each approach 5.