From the Research
A dorsal approach for distal radius fractures is selected when there is significant dorsal displacement of fracture fragments, dorsal comminution, or when the fracture extends into the dorsal rim of the radius, as supported by the most recent study 1.
Key Indications for Dorsal Approach
- Significant dorsal displacement of fracture fragments
- Dorsal comminution
- Fracture extension into the dorsal rim of the radius
- Dorsal Barton patterns
- Dorsal die-punch fragments
- Articular involvement requiring direct visualization of the joint surface from the dorsal aspect
Surgical Technique
When performing a dorsal approach, the surgeon typically makes an incision over the dorsal wrist, carefully identifying and protecting the extensor tendons and the dorsal sensory branch of the radial nerve. The extensor retinaculum is incised, and the extensor compartments are retracted to expose the fracture site. This approach may require more extensive soft tissue dissection compared to the volar approach and carries a higher risk of extensor tendon irritation or rupture if hardware prominence occurs. Therefore, low-profile plates or buried K-wires are often preferred when using this approach, as noted in 2 and 1.
Postoperative Care
Postoperatively, patients typically require protection in a splint for 1-2 weeks followed by early motion to prevent stiffness, which is particularly important after dorsal approaches due to the proximity to the extensor mechanism. The study 1 highlights the importance of early motion and reports satisfactory outcomes with this approach.
Evidence Summary
The most recent and highest quality study 1 supports the use of a dorsal approach for distal radius fractures with dorsal comminution or associated dorsal die punch fragments, providing an alternative to dorsal plate fixation. This study, along with others 3, 2, 4, 5, emphasizes the importance of careful patient selection and surgical technique to minimize complications and optimize outcomes.