With the advent of fixed angle devices, volar fixation of dorsally displace distal radius fractures is being recognized as a valid treatment option. Complex (Fernandez type 3) displaced articular fractures are a sub-set of these injuries that present more difficulty in treatment and a worse prognosis. This paper reviews our experience managing displaced articular fractures of the distal radius with internal fixation applied through a volar approach.

Methods:

We reviewed retrospectively patients with complex articular fractures treated at our centers between January 1998 and March 2001. We used the extended FCR approach for exposure and fixation was provided with the DVR fixed angle volar plate. Fractures were classified according to Malone and the “Comprehensive Classification of Long Bone Fractures”. At final follow-up, standard radiographic fracture parameters were measured and final functional results where assessed by measuring digital motion, wrist motion and grip strength.

Results:

Of 46 patients fitting the inclusion criteria, we followed 43 patients with 45 intra-articular distal radius fractures for an average of 58 weeks. Three patients were lost to follow-up. Final volar tilt averaged 6 deg., radial tilt 20 deg., articular displacement averaged <1 mm and radial shortening also averaged <1 mm. The average final dorsiflexion was 55 deg., volar flexion 53 deg., pronation 78 deg. and supination 74 deg. Grip strength was 83 % of the contra-lateral side. There were no plate failures or significant loss of reduction, slight residual articular mal-reduction tended to remodel at the one year follow-up.

Conclusion:

Complex articular fractures of the distal radius can be anatomically reduced through the extended FCR approach and adequate fixation can be provided by the DVR plate. The technique is somewhat complex and requires attention to detail. Volar fixation of complex articular fractures of the distal radius produces excellent functional results.