Current Concepts in Volar Fixed-angle Fixation of Unstable Distal Radius Fractures

Abstract

We present new developments in the volar treatment of un- stable distal radius fractures in adults. New perspectives on the anatomy of the wrist, the watershed line on the volar radius and the usefulness of the pronator fossa are presented and these help to avoid flexor and extensor tendon distur- bance when using a volar approach. Other new insights on the bony anatomy of the distal end of the radius are dis- cussed, which are important in improving the quality of frac- ture fixation, including the benefits of constructing a precise fixed-angle scaffold underneath the articular surface in or- der to stabilize it. A volar fixed-angle plate must support the dorsal, central and volar aspects of the subchondral bone in order to stabilize the most complex fractures. Awareness of the anatomy of blood supply to the distal radius: the dorsal retinaculum that feeds the distal fragments and the blood supply to the diaphysis through branches of the anterior interosseous artery is necessary to maximize healing poten- tial and avoid complications. Volar fixed-angle plates need to withstand very high forces during rehabilitation, the magni- tude of these forces are up to five times the loads applied on the hand. Level of Evidence: Level V (expert opinion). See the Guide- lines for Authors for a complete description of levels of evi- dence.