Volar Plating of Distal Radius Fractures

Indications

Distal Radius Fixation, radiographs of a distal radius fracture fixed with a volar plate
Radiographs of a distal radius fracture fixed with a volar plate. Image by DavidIvar, Wikimedia Commons, CC BY-SA 4.0.
  • Unstable or displaced intra-articular fractures
  • Loss of reduction in plaster
  • Volar shear (Smith and Barton) fractures
  • Acceptable alignment after closed reduction is radial inclination over 15 degrees, radial shortening under 3 mm and dorsal tilt under 10 degrees
  • Older low demand patients do well in plaster despite malunion

Position

  • Supine, arm table, upper arm tourniquet
  • Image intensifier and hand table
  • Supinate the forearm

Operative Steps

  1. Modified Henry approach through the FCR sheath
  2. Retract FPL ulnarly and release pronator quadratus from the radius
  3. Reduce the fracture, using the brachioradialis release if needed
  4. Plate proximal to the watershed line to avoid flexor tendon irritation
  5. Distal screws short of the dorsal cortex to protect extensor tendons
  6. Check DRUJ stability after fixation
  7. Use the plate as a buttress for volar shear fractures
  8. Check the joint with a tilted lateral view
  9. Dorsal or fragment specific fixation for dorsal shear or die punch fragments

Postoperative Care

  • Early finger and wrist motion
  • Splint for comfort
  • Hand therapy for stiffness
  • Return to heavy work at about 3 months

Complications

  • FPL rupture from a prominent plate
  • Extensor tendon rupture from long screws
  • Median nerve symptoms and CRPS
  • Loss of reduction
  • Malunion with ulnar impaction
  • Infection is uncommon

Related Pages

Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.