Multifragmentary Distal Radius Fracture (Volar Approach)

Master the surgical treatment of multifragmentary distal radius fractures with this training focused on the volar approach. The procedure aims to restore radial length and articular congruity, using a combination of manual traction, provisional percutaneous fixation, and a fixation strategy with a volar plate and screws of different lengths to stabilize the multiple fragments, including the dorsal component, without the need for an additional dorsal approach.

Training Focus:

• Treatment of multifragmentary distal radius fractures.
• Volar approach for reduction and fixation.
• Strategies to restore radial length and articular congruity.
• Fixation with a volar plate and screws of different lengths.
• Stabilização do componente dorsal sem acesso adicional.

Conteúdo Detalhado:

• Avaliação e Redução Provisória: O treinamento abrange a análise de imagens de fraturas multifragmentárias do rádio distal e redução por tração manual (ligamentotaxia). Inclui fixação percutânea provisória com fios K no estiloide radial e no tubérculo de Lister para estabilização dos fragmentos.
• Acesso Cirúrgico Volar: Detalhes da incisão, coagulação e dissecação dos planos teciduais. Ensina como retrair tendões (flexor longo do polegar e flexor radial do carpo ulnarmente) e proteger a artéria radial radialmente para um amplo acesso. A fáscia é incisa linearmente.
• Exposure of the Pronator Quadratus: The course covers the identification of the pronator quadratus and how to position retractors. A needle delineates the articular margin. Access to the pronator quadratus is made in an L-shape, with subperiosteal elevation to expose the fracture lines, observing the already reduced volar surface.
• Preparation and Volar Fixation: Retractors are exchanged, fracture vertices are cleaned, and the plate is introduced respecting the articular margin. It begins with a cortical screw in the oval hole for compression. Short screws are used to fix the volar fragment, and with digital maneuvers, long screws stabilize the dorsal surface without the need for another approach. The short screws are exchanged for long ones (18–20 mm), including the styloid, completing the osteosynthesis in the remaining holes.
• Closure and Final Results: The pronator quadratus is sutured in a straight fashion. The reduction is satisfactory, with radial anatomy close to normal. Skin closure is performed for a satisfactory outcome.

Included Material:

• Detailed PDF: Covers provisional fixation, volar surgical approach, radius exposure and plate implantation, and closure and final results. It also includes a practical summary of the procedure with key points.

Enhance your wrist surgery skills. Enroll now and master the techniques for treating multifragmentary distal radius fractures, ensuring functional restoration and stability for your patients.