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A New Single Volar Approach for Epiphyseal Ulnar and Radial-sided Comminutive Fracture of the Distal Radius: The Mediolateral Windows Approach

Mares, Olivier MD*,†; Graves, Marc Andre MD; Bosch, Christophe MD*,†; Chammas, Michel MD, PhD*,†; Lazerges, Cyril MD

Techniques in Hand & Upper Extremity Surgery: March 2012 - Volume 16 - Issue 1 - p 37–41
doi: 10.1097/BTH.0b013e3182351dfc

Articular comminuted distal radius fractures are still a surgical challenge. The development of volar locking plate device allows a stable and anatomic restoration of the distal radius. We propose a modification of the classic anterior approach for articular fracture of the distal radius with ulnar impaction. By a single incision, we realize 2 windows to expose the medial and lateral column of the distal radius. This technique is indicated for complex articular distal radius fractures associated with an ulnar comminution. The dissection is extended superficially to the ulnar side of the carpal tunnel elements by a blunt dissection of the anterior part of the wrist between the skin and the superficial layer of the flexor carpi radialis, in subcutaneous tissues and the antebrachial fascia to preserve the sensitive branch of the median nerve. This new approach allows reduction of each fragment of a comminutive articular fracture without exposing the flexor tendon and median nerve to excessive tension. In our surgical armatorium, we reserved this technique for distal radius fractures with articular ulnar damage because of the possible risk to the median cutaneus branch.

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*Department of Hand and Upper Extremity and Nerve Repair, Montpellier Medical University UM1, Rue école de de médecine, Montpellier

CHRU Montpellier Lapeyronie, France

Department of Traumatology, Sherbrooke University, Quebec, Canada

Conflicts of Interest and Source of Funding: The authors report no conflicts of interest and no source of funding.

Address correspondence and reprint requests to Olivier Mares, MD, Montpellier Medical University UM1, Rue école de de médecine, 34000 Montpellier France. E-mail:

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