Introduction: The distal radius is the most commonly fractured bone. Its treatment, replete with complex classification schemes and manufacturer supported hardware alternatives is in a penumbra between orthopedic and hand surgery. The purpose of this report is to demonstrate that the most satisfactory treatment of this fracture is within the realm of plastic surgery.

Materials and Methods: All procedures were performed under regional anesthesia with sedation in the ambulatory setting. In every case, regardless of the fracture pattern, its angulation or comminution, a volar approach and a volar fixed angle plate device (DVR, Hand Innovations) were utilized. An endoscopic release of the transverse carpal ligament was performed in every case, whether therapeutically or prophylactically. The volar approach (described in the presentation) provides ample exposure of the fracture fragments, ligamentotaxis of the wrist helps achieve a precise reduction, and the fixed angle pegs drilled in the subchondral bone provide a stable fixation. The pronator quadratus is replaced as a flap to cover the plate and protect the tendons. Postoperative casting is limited to 2-4 weeks and patients were routinely referred to therapy. The clinical results were evaluated radiographically and functionally at the last visit.

Results: Over the past four years, the author has operated on 240 unstable fractures of the distal radius in 232 patients and followed 228 patients with 236 fractures for an average of 29 weeks (4 lost to f/u). Patient’s age ranged from 16 to 89 with 146 females and 82 males. The surgical procedure took 36 minutes on the average. The average time with a post-operative cast or splint was three weeks. The average final ROM was 62º extension, 59º flexion, 82º pronation and 80º supination. Grip strength was 80% of the contra-lateral side. No external fixator and no bone grafts were needed. Complications consisted of one loss of reduction, one delayed healing, three cases of RSD that responded to prompt treatment and three re-operations for hardware removal.

Conclusion: The results of this plastic surgeon’s series compare very favorably with the best reports in the literature. The volar approach with volar fixed angle plating is a novel, elegant and straightforward treatment of distal radius fractures. By being universally applicable regardless of the fracture pattern this approach takes away the confusion and mystique perpetrated in the literature. Treatment of distal radius fractures is an integral part of hand surgery and is clearly within the territory of plastic surgery.