The extended flexor carpi radialis approach: a new perspective for the distal radius fracture.

Volar fixation of dorsally unstable distal radius fractures is a new method of treatment that provides the benefits of stable internal fixation without the complications of the dorsal approach. A new, fixed-angle fixation device, the distal volar radius (DVR) plate, (Fig. 1) has been introduced for this purpose. Experience gained by applying this technique to clinically complex cases led us to the realization that more exposure, especially in a dorsal direction, was necessary than that provided by the traditional volar approaches. The need to reduce fractures with significant articular displacement (Fig. 2) and the need to release dorsal callus in inveterate fractures or nascent malunions led us to use an extended form of the flexor carpi radialis (FCR) approach. Volar displaced distal radius fractures are commonly managed with volar buttress plates through the FCR approach. This approach goes deep to the forearm fascia through the FCR tendon sheath and is continuous with the distal part of the Henry approach. The traditional FCR approach provides access to the volar aspect of the distal radius, the volar wrist capsule, and the scaphoid. In comparison with dorsal approaches, which present a high incidence of extensor tendon problems, the FCR approach is relatively free of complications. We extend the FCR approach by releasing the radial septum, by mobilizing the proximal radial fragment, and by using the fracture plane for exposure or what is known as intrafocal technique. Therefore, understanding the anatomy of the radial septum is important. On its proximal aspect, it is a simple fascial wall separating the flexor and extensor compartments of the forearm. At the level of the radial metaphysis, the radial septum is a complex fascial structure that includes the first extensor compartment and the insertion of the brachioradialis. More distally, the radial septum forms the radial insertion of the carpal ligament and ends as the FCR tendon sheath approaches the tuberosity of the scaphoid. The proximal radial fragment has a dependable endosteal blood supply that permits its subperiosteal release and subsequent mobilization. Pronating this fragment out of the way provides wide exposure of the fracture surfaces. This allows the volar reduction and fixation of even the most complex dorsally displaced distal radius fractures. Address correspondence and reprint requests to Dr. Jorge L. Orbay, Miami Hand Center, 8905 SW 87 Ave., Suite 100, Miami, Florida 33176; e-mail: [email protected] Techniques in Hand and Upper Extremity Surgery 5(4):204–211, 2001 © 2001 Lippincott Williams & Wilkins, Inc., Philadelphia