Evaluation of the Distal Extent of Visualization Using Volar Approaches for Fixation of Distal Radius Fractures

Purpose: Distal radius fractures may include difficult-to-treat fractures of the volar ulnar corner, colloquially termed as the "critical corner." These fragments are problematic because they are often missed, and their fixation is difficult. We aimed to compare the distal extent of the exposure of the volar surface of the distal radius between the classic Henry approach and the extended flexor carpi radialis (EFCR) approach.

Methods: Thirteen matched-pair specimens were randomized to receive either the Henry approach or the EFCR approach to the volar distal radius. A mini Hohmann retractor provided retraction at the level of the critical corner. The force needed to attain a standardized angle of retraction at 60° was measured. A 0.062-inch Kirschner wire was placed at the most distal and most ulnar point that was visible from a position directly above the incision. Each distal radius was removed from the specimens. A digital caliper was used to measure the distance from the pin hole to the articular margin of the lunate fossa, along a line parallel to the long axis of the radius.

Results: The pin was significantly closer to the articular margin in the EFCR approach (mean, 2.94 ± 1.69 mm) than in the Henry approach (mean, 9.70 ± 2.70 mm).

Conclusions: Our results demonstrated significantly more distal visualization of the volar distal radius in the EFCR approach compared to the Henry approach.

Clinical relevance: Adequate exposure of the volar surface of the distal radius is crucial for assessment and fixation of the volar ulnar corner. Complete visualization of the volar ulnar corner improves surgeons' ability to detect a volar marginal fragment and adequately fix this fragment.