The use of minimally invasive volar approach in the surgical treatment of patients with distal radius fractures

Abstract. Past time, in the literature there has been an increasing interest of using minimally invasive volar approach for surgical treatment of patients with distal radius fractures allowing, on the one hand, not to damage vascularity of bone fragments and active stability of distal radioulnar joint, and on the other hand – giving possibility to do all repositional and fixational steps.

The aim of the study is to assess results of minimally invasive volar approach for surgical treatment of patients with distal radius fractures.

Material and Methods. We analyzed results of surgical treatment of 68 patients (48 female and 20 male) with distal radius fractures treated in the period from November 2015 to December 2021 using minimally invasive volar approach. In all cases for fixation we used volar locking plate. The mean age was 39,26±7,66 years (21-58 years). Fractures were classified according to Fernandez classification system as type I – 41 cases (60,3%), type II – 12 cases (17,6%) and type III – 15 cases (22,1%). The minimal follow-up after the surgery and discharge was 3 months, until the final functional result. X-rays (consolidation’s signs, volar tilt, radial height, radial inclination, joint congruency as well as distal radioulnar joint congruency), functional (flexion/extension of the wrist, forearm rotation and grip strength) and cosmetic results were evaluated during follow-up period. The overall results were assessed on the basis of Gartland & Werley score.

Results. Primary union of distal radius was achieved within 6 weeks after the surgery in 66 patients (97,1%), confirmed by X-rays. In 2 cases (2,9%) we didn’t achieve bone union even after 6 months, that was detected as false joint of distal radius and required re-operation. After 3 months according to Gartland & Werley score 52 patients (76,5%) had an excellent results, 14 (20,6%) – good, 2 (2,9%) – fair. There were no poor results. In 3 cases (4,4%) there were sensitive problems in the field of thenar due to intraoperative damage of palmar branch of median nerve during surgical approach. There were no any complications. The cosmetic result was excellent in all cases.

Conclusions. The usage of minimally invasive volar surgical approach for plate fixation of distal radius fractures is spectacular and effective tool of treatment result’s improvement for patients with such kind of trauma. The possibility of preservation of m. pronator quadratus, bone vascularity, contributing to bone healing, lower risk of infectional complications, faster functional recovery and better patient’s satisfaction about cosmetic result are the main arguments for using such technique.

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