The Flexor Carpi Radialis Portal for Arthroscopy-Assisted Reduction of the Dorsal Ulnar Fragment in Distal Radius Fractures

Abstract

Background The importance of the dorsal ulnar fragment (DUF) for stability and articular congruence of the radius is widely recognized, and standard surgical techniques often fail to ensure its reduction. Description of Technique We describe a modification of volar wrist portals for arthroscopic management of the DUF of the distal radius. It is made in an outside-in fashion in line with the flexor carpi radialis (FCR) approach for the distal radius. Through this volar portal, we achieve wide and direct visualization of the DUF, with the advantage of protecting important anatomic structures such as the FCR tendon, the radial artery, and the median nerve; all protected with the previously made volar approach for the distal radius. In addition, easy manipulation and reduction of the DUF is obtained with instrumentation through standard dorsal portals. Patients and Methods We performed this procedure in 23 patients with distal radius fractures (DRF) with displaced DUF. Results Early and late postoperative evaluation demonstrated intraoperative reduction maintenance and adequate range of motion, compatible with the usual findings of standard volar plating, with the benefit of anatomic reduction of the DUF. Conclusion With our technique, volar plating associated with arthroscopy-assisted dorsal fragment specific fixation with dorsal standard and the FCR portals permits optimal surgical treatment of most DRFs.

Keywords: distal radius; fragment-specific fixation; volar wrist portals; wrist arthroscopy.

Fig. 1

Positioning for arthroscopy-assisted distal radius fracture treatment ( A ). With the plate already in position, a needle is placed through the deep FCR tendon sheath at a point just distal to the end of the plate ( B ). With the optic placed volarly, through the FCR portal, the surgeon can easily reduce the dorsal ulnar fragment ( C ). FCR, flexor carpi radialis.

Fig. 2

The flexor carpi radialis portal allows full visualization of the dorsal ulnar fragment, allowing accurate reduction with dorsal instrumentation trough portal.

Fig. 3

Computed tomography scan showing a case of distal radius fracture with a displaced dorsal ulnar fragment ( A ). Reduction of the fragment almost entirely visualized through the FCR portal ( B ). After temporary fixation of the fracture through standard FCR approach, the dorsal ulnar fragment may be reduced with direct visualization through the portal ( C ). FCR, flexor carpi radialis.