Technique, Indications and Limitations of a Minimally Invasive Approach to Treat Distal Radius Fractures and Malunions

Abstract

The minimally invasive flexor carpi radialis approach can be used for volar locking plate fixation of distal radius fractures. It offers the advantage of preserving ligamentotaxis, which facilitates the reduction and the small size of the scar improves the esthetic result of the procedure. It is indicated for extra-articular fractures of the distal radius. In the case of an intra-articular fracture, an arthroscopy may be associated. In the case of a proximal diaphyseal extension of the fracture, a second proximal approach can be added in order to use a longer plate. Relative contraindications are comminuted articular fractures in elderly osteoporotic patients. Functional and radiological results are comparable to those obtained with the extented flexor carpi radialis approach. A conversion of the procedure for a larger incision is always possible in the case of a difficult reduction.

Zusammenfassung

Der minimal-invasive Zugang über der Flexor carpi radialis-Sehne kann für die palmare Plattenosteosynthese von distalen Radiusfrakturen verwendet werden. Vorteile dieses Zugangs sind, dass durch die erhaltene Ligamentotaxis die Frakturreposition erleichtert und durch die geringe Größe der Narbe das ästhetische Ergebnis des Verfahrens verbessert wird. Er ist für extraartikuläre Frakturen des distalen Radius indiziert. Bei einer intraartikulären Fraktur kann eine Arthroskopie ergänzt werden. Im Falle einer proximalen diaphysären Ausdehnung der Fraktur kann ein zweiter proximaler Zugang hinzugefügt werden, um eine längere Platte zu verwenden. Relative Kontraindikationen sind Gelenktrümmerfrakturen bei älteren osteoporotischen Patienten. Die funktionellen und radiologischen Ergebnisse sind vergleichbar mit denen, die mit dem erweiterten Flexor carpi radialis-Zugang erzielt werden. Im Falle einer schwierigen Reposition kann man intraoperativ immer von einem minimal-invasiven Zugang auf eine größere Inzision umsteigen.

Keywords

fractures - MIPO - distal radius - minimally invasive - extended FCR approach - minimally invasive FCR approach

Schlüsselwörter

Fraktur - MIPO - distaler Radius - minimal-invasiv - erweiterter FCR-Zugang

Publikationsverlauf

Eingereicht: 20. Juli 2022

Angenommen: 15. September 2022

Artikel online veröffentlicht:
30. Januar 2023

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