Kamano M, Orthopaedic Surgery, Baba Memorial Hospital, 4-244, Hamaderahunaocho Higashi, Sakai, Japan
Materials and method: We treated 65 cases of the fracture of the distal radius by a palmar plating nevertheless the direction of the displacement of the distal fragment. 15 cases was Smith type and 50 were Colle’s type. The mean age was 48 at the time of injury and the mean follow-up time was 9 months. The operative approach between the radial artery and the flexor carpi radialis was employed. After detachment of the pronator quadratus muscle from its radial border, the palmar plating was performed after reduction. For prevention of the displacement of the distal fragment dorsally, especially in a case of Colles’ type fracture, anatomical reduction of the palmar cortex and the definite location of three screws which fixed the distal fragment were more important than those in the treatment of Smith type. Three cancellous screws should be inserted into the subchondral area near the wrist and the distal radioulnar joint, and into the radial styloid. All distal screws should not penetrate the dorsal cortex for preventing injuries to the extensor tendons. After plating, the plate and screws were covered with the pronator quadratus for protection of the flexor tendons and the median nerve. The clinical results were evaluated with the system of Gartland and Werley. Radiographic parameters were measured three times, before and after the operation, and at the final examination. Clinical results: There were 48 excellent and 15 good and 2 fair. The two fair cases had concomitant fractures of the scaphoid and the ulna, or the fracture-dislocatio of the elbow which resulted in RSD. In the present study, there were no extensor or flexor tendon injuries. Each radiographic data have been maintained since the surgery. There was no case in which the distal fragment re-dislocated after operation. Conclusion: The dorsal approach requires exploration of the extensor retinaculum and the extensor tendons. In addition, the resection of Lister’s tubercle may be required. On the contrary, the palmar plating can avoid injuries to the extensor tendons that has been reported as a serious complication after dorsal plating. The palmar approach and plating is safe and effective in the treatment for the both type of the distal radius fracture.