What is the step-by-step procedure for a dorsal and lateral plating surgical procedure for a fracture of the distal end of the radius?

From the Guidelines

The dorsal and lateral plating procedure for distal radius fractures is a complex surgical technique that involves several key steps to ensure proper reduction and fixation of the fracture, as recommended by studies such as 1. The procedure begins with the patient positioned supine with the affected arm on a radiolucent table under general or regional anesthesia.

• The surgeon starts with a dorsal approach, making a longitudinal incision (approximately 8-10 cm) centered over the distal radius, carefully identifying and protecting the extensor tendons and sensory branches of the radial nerve.
• After exposing the fracture site, the fragments are reduced under direct visualization and with fluoroscopic guidance, as suggested by 1 for fractures with postreduction radial shortening >3 mm, dorsal tilt >10°, or intra-articular displacement.
• Temporary K-wires may be used to hold the reduction in place.
• For the dorsal plate, the surgeon selects an appropriately sized low-profile plate (typically 2.4mm or 2.7mm) and positions it on the dorsal surface of the radius, taking care to avoid penetrating the articular surface or extensor tendon irritation.
• The plate is secured with locking and non-locking screws.
• For the lateral (radial) plate, either the same incision can be extended or a separate incision is made along the radial border, and the first dorsal compartment is retracted.
• The radial plate is applied perpendicular to the dorsal plate in a buttress fashion, providing enhanced stability for complex distal radius fractures with both dorsal and radial comminution, as noted in 1.
• After plate fixation, the surgeon confirms reduction and hardware placement with fluoroscopy, tests wrist motion, performs thorough irrigation, and closes in layers.
• Postoperatively, a splint is applied for 1-2 weeks, followed by early protected range of motion exercises, with the goal of restoring radial length, inclination, and tilt, as well as realigning the articular fracture fragments, as emphasized in 1. The dual-plating technique is particularly useful for complex distal radius fractures, although it carries slightly higher risks of tendon irritation and hardware prominence compared to single-plate techniques, highlighting the need for careful patient selection and surgical technique, as discussed in 1.

From the Research

Procedure Overview

The procedure for a dorsal and lateral plating surgical procedure for a fracture of the distal end of the radius involves several steps:

• Preoperative preparation: The patient is prepared for surgery, which may include the use of wide-awake local anesthesia with no tourniquet (WALANT) or general anesthesia 2, 3.
• Incision and exposure: A dorsal incision is made to expose the fracture site, and the fracture is reduced and stabilized using a dorsal plate 4.
• Plate fixation: The dorsal plate is fixed to the bone using screws, and a lateral plate may also be used to provide additional stability 5, 6.
• Closure: The incision is closed, and the patient is taken to the recovery room.

Step-by-Step Procedure

The step-by-step procedure for a dorsal and lateral plating surgical procedure for a fracture of the distal end of the radius is as follows:

• Step 1: Preoperative preparation - The patient is prepared for surgery, which may include the use of WALANT or general anesthesia 2, 3.
• Step 2: Incision and exposure - A dorsal incision is made to expose the fracture site, and the fracture is reduced and stabilized using a dorsal plate 4.
• Step 3: Reduction and stabilization - The fracture is reduced and stabilized using a combination of dorsal and lateral plates 5, 6.
• Step 4: Plate fixation - The dorsal and lateral plates are fixed to the bone using screws 5, 6.
• Step 5: Closure - The incision is closed, and the patient is taken to the recovery room.

Considerations and Complications

Considerations and complications for the procedure include:

• Choice of plate: The choice of plate depends on the fracture type, patient factors, and surgeon experience 5.
• Complications: Complications associated with plating include tendon irritation or rupture and the need for plate removal 6, 4.
• Anesthesia: The use of WALANT or general anesthesia should be considered, with WALANT offering advantages such as reduced preparation time and postoperative hospitalization 3.