Current concepts in volar fixed-angle fixation of unstable distal radius fractures.

UNLABELLED We present new developments in the volar treatment of unstable distal radius fractures in adults. New perspectives on the anatomy of the wrist, the watershed line on the volar radius and the usefulness of the pronator fossa are presented and these help to avoid flexor and extensor tendon disturbance when using a volar approach. Other new insights on the bony anatomy of the distal end of the radius are discussed, which are important in improving the quality of fracture fixation, including the benefits of constructing a precise fixed-angle scaffold underneath the articular surface in order to stabilize it. A volar fixed-angle plate must support the dorsal, central and volar aspects of the subchondral bone in order to stabilize the most complex fractures. Awareness of the anatomy of blood supply to the distal radius: the dorsal retinaculum that feeds the distal fragments and the blood supply to the diaphysis through branches of the anterior interosseous artery is necessary to maximize healing potential and avoid complications. Volar fixed-angle plates need to withstand very high forces during rehabilitation, the magnitude of these forces are up to five times the loads applied on the hand. LEVEL OF EVIDENCE Level V (expert opinion).