What structures are observed step by step during dissection in a dorsal plating procedure for a distal radius fracture?

From the Guidelines

The primary structures observed during a dorsal plating procedure for a distal radius fracture include the skin, subcutaneous tissue, extensor retinaculum, extensor pollicis longus tendon, dorsal wrist capsule, and the distal radius fracture site itself. During this procedure, the dissection sequence is crucial for minimizing complications and achieving optimal outcomes. The process begins with an incision through the skin and subcutaneous tissue over the dorsal aspect of the wrist.

• Key steps in the dissection include:
  • Incising the extensor retinaculum, typically between the third and fourth extensor compartments, as suggested by the principles outlined in 1.
  • Identifying and retracting the extensor pollicis longus tendon radially to prevent injury.
  • Incising the dorsal wrist capsule to expose the fracture site, taking care to protect the extensor tendons.
  • Reducing the fracture and exposing the dorsal cortex of the radius for plate application. The approach must be meticulous to avoid injury to the extensor tendons and branches of the superficial radial nerve, which can lead to postoperative complications such as tendon irritation or rupture, emphasizing the importance of careful surgical technique as implied by the treatment guidelines for distal radius fractures 1.
• Important considerations during the procedure include:
  • Protecting the extensor tendons throughout the dissection and fracture reduction.
  • Carefully repairing the extensor retinaculum during closure to maintain the integrity of the extensor tendon compartments.
  • Ensuring precise reduction and stable fixation of the fracture to promote healing and minimize the risk of complications, in line with the recommendations for surgical fixation of certain types of distal radius fractures 1.

From the Research

Dorsal Plating Procedure for Distal Radius Fracture

The dorsal plating procedure for a distal radius fracture involves several steps, with various structures being observed during dissection. The key structures include:

• Extensor tendons crossing the wrist joint
• Extensor retinaculum (ER) enveloping the distal dorsal end of the radius 2
• Dorsal cortical surface of the radius, where screws may be placed for plating
• Third compartment of the wrist, which contains the extensor pollicis longus (EPL) tendon

Step-by-Step Dissection

During the dissection process, the following structures are observed:

• The extensor retinaculum is identified and may be sectioned to allow for adequate exposure of the distal radius fracture 2
• The extensor tendons are retracted to allow for access to the dorsal surface of the radius
• The dorsal cortical surface of the radius is exposed, and screws are placed for plating
• The third compartment of the wrist is identified, and the EPL tendon is protected to prevent injury or rupture 3

Important Considerations

It is essential to take precautions to avoid complications, such as:

• Extensor tendon irritation or rupture, which can be caused by prominent dorsal screws or direct intraoperative damage 4, 3
• Dorsal cortical penetration of screws, which can contribute to extensor tendon irritation 5
• Flexor tendon complications, which can arise when using volar locking plates 6