Fig. 18.1 Orbay described the so-called “extended FCR approach” for comminuted articular fractures. His rationale is to use the carpus as a mold when reducing the articular fragments. This is performed under direct visualization. I fully agree with his raison d’être of the extended FCR approach: not to violate the dorsal compartments. However, at this point, I am sure readers will agree that you can perform the articular reduction arthroscopically. Nevertheless, as the saying goes, “it takes all kinds to make a world”; I feel that Orbay’s approach has merit in certain situations, such as when fragments are deeply jammed within the metaphysis. Therefore, although the case that is discussed in this chapter is a malunited jammed fragment, I would like to make a remark regarding jammed fragments in the acute setting.

Fig. 18.3 The Orbay approach was used. The radius was pronated (a), and this exposed the lunate fossa fragment, which was trapped dorsally in the metaphysis (b). The fragment was then released (c). Then, following Orbay’s technique, the FOF was reduced using the lunate as the mold; the radius shaft was pronated and a plate was applied. In addition, I performed an arthroscopic confirmation of reduction prior to definitive fixation of the articular fragments.

Fig. 18.7 This 22-year-old mechanic sustained a distal radius fracture from a high-speed motor vehicle accident while racing 8 weeks prior to presentation. It had been previously fixed through combined volar radial and midline dorsal approaches. K-wires, volar bone anchors, and an external fixator were used for fixation. The external fixator had been removed 2 weeks prior, but despite this he had minimal wrist range of motion. His surgeon had referred him to the pain clinic and advised him that he would likely require a wrist fusion in 6 months. This prompted his search for a second opinion. The images demonstrate his maximal supination and wrist extension.