Distal Radius Fracture Volar Approach and the flexor carpi radialis sheath. A Regional and National Questionnaire Survey

Abstract

Introduction Different approaches have been described for volar plating of distal radius fractures. Accordingly, access to the deep volar compartment may be done through the flexor carpi radialis (FCR) tendon sheath (FCR approach) or between the radial artery and the FCR tendon, without violating the aforementioned sheath (classic Henry approach). We have not been able to find any study neither comparing both approaches nor focusing on the potential benefits or risks of each. Our hypothesis is that there is a disparity of opinion between surgeons operating distal radius fractures about which approach is better.

Materials and methods An anonymous internet cross-sectional self-completion questionnaire was sent as an email to the members of Societat Catalana de Cirurgia Ortopèdica i Traumatologia (SCCOT) as well as the members of the Sociedad Española de Cirugía de Mano (SECMA) in order to evaluate their preferences on how to manage the FCR tendon sheath during volar distal radius exposure. Analysis was done using SurveyMonkey analyzing software (Momentive Inc., San Mateo, California, EE. UU. www.momentive.ai) with cross-table data, and trends were extrapolated.

Results From October 2020-2021 a total of 99 answers were obtained, 55 Upper Limb/Hand and 41 General Orthopaedic Surgeons. 72,72% usually open the FCR sheath and 63% of them think this surgical gesture facilitates their surgery. 21,21% prefer to preserve FCR tendon sheath and 53% choose this approach because it causes less complications. Excessive scarring and iatrogenic neurovascular injury are the most feared complications.

Conclusion The disparity of opinions shown in this survey towards opening or preserving the FCR tendon sheath and the justification given might serve as a basis for designing clinical studies comparing both approaches.

Keywords

Radius Fracture - volar approach - flexor carpi radialis - tendon sheath

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