Minimally invasive plate osteosynthesis for distal radius fractures using a 3-point positioning technique.

Background: The volar approach with plate fixation is the gold standard for treating distal radius fractures, often requiring incision of the pronator quadratus (PQ) muscle. Preserving the PQ during surgery may facilitate early postoperative recovery. However, conventional minimally invasive plate osteosynthesis (MIPO) techniques frequently necessitate multiple (3-4) intraoperative fluoroscopic adjustments to achieve optimal plate positioning, which can inadvertently damage the PQ muscle. Based on our clinical observations, we developed a novel 3-point positioning technique to minimize PQ injury while ensuring accurate plate placement. Preliminary results demonstrate promising early clinical outcomes.

Aim: To retrospectively analyze distal radius fractures treated using the 3-point positioning-assisted MIPO technique with preservation of the PQ.

Methods: The 3-point positioning technique was applied: The Kirschner wire was inserted after fluoroscopy and was correctly adjusted the position of the plate above the PQ. With the aid of Kirschner wires positioning the PQ stripping was performed only once, and the plate then placed in a correct and satisfactory position. Operation time, incision length, wrist pain score, upper extremity function disabilities of the arm, shoulder and hand (DASH) score, wrist Gartland-Werley score, wrist grip strength, and range of motion were among the quantitative variables recorded. Qualitative variables including AO fracture classification, intraoperative and postoperative complications were evaluated.

Results: At a mean follow-up of 6.9 ± 0.8 months, the mean scar length was 25.4 ± 1.5 mm, the pain score was 0.7 ± 0.6, the DASH score for the upper limb was 4.7 ± 1.3, and the Gartland-Werley score for wrist function was 4.1 ± 1.1 at the last follow-up. Mean flexion was 97.3%, extension was 97.0%, pronation was 98.9%, supination was 98.9%, and grip strength was 86.6% compared to contralateral values. No unfavorable intraoperative or postoperative complications occurred.

Conclusion: The 3-point positioning technique may reduce the damage to the PQ muscle and is a safe and effective method for MIPO for distal radius fractures.