Intra-articular Fractures of the Distal Radius Treated with Dorsal Plate

Displaced intra-articular fractures with dorsal cortical comminution, minimal displacement, and no comminution of the palmar cortex.

Open the retinaculum over the second (II) through fourth (IV) extensor compartments as two opposing flaps (Fig. 3-1A,B).
Reduce the articular surface starting with sigmoid notch and lunate fossa. Attempt indirect reduction of the joint with the assistance of fluoroscopy. If the reduction does not appear adequate, the joint can be exposed through a transverse arthrotomy.

Figure 3-1

If the distal fragment is malrotated, reduction may be facilitated by releasing the brachioradialis.

Hold the reduction with 0.045 in. wire(s) placed through the radial styloid.
Graft metaphyseal defects with autogenous or banked bone.
Apply dorsal plate and place screws in radial styloid and in radial shaft.
Check reduction with intraoperative radiograph.
Fill remaining holes in the plate as the fracture pattern permits. A dorsal plate that accommodates smooth pins or screws with heads that thread into the plate converts the implant to a fixed-angle device. The pins can serve as a buttress for comminuted portions of the subchondral plate (Fig. 3-2).