A Stepwise Intraoperative Protocol to Minimize Complications after Volar Plating

• Published in: Journal of wrist surgery Vol. 12; no. 5; pp. 384 - 389
• Main Authors: Goorens, Chul Ki, Eetvelde, Gilles Van, Debaenst, Niels, Royen, Kjell Van
• Format: Journal Article
• Language: English
• Published: United States Thieme Medical Publishers, Inc 01.10.2023
• Subjects: Special Review; distal radial fracture; protocol; volar plate; complications
• ISSN: 2163-3916; 2163-3924
• DOI: 10.1055/s-0043-1760736

Although outcome of volar plating is generally good, care should be taken to avoid specific iatrogenic and preventable complications, with an incidence reporting averaging 15%. Flexor tendon rupture due to a prominent plate, extensor tendon rupture due to a dorsal protruding screw tips, cartilage lesions due to intra-articular screw placement, loss of reduction due to insufficient stability, and persisting ulnar pain with distal radioulnar joint instability due to unstable triangular fibrocartilaginous complex lesions or unstable ulnar styloid base fractures all have been described.  We believe that a majority of these complications can be prevented by meticulous assessment of several intraoperative parameters during volar plating. Therefore, we introduce the WRIST protocol, a stepwise easy-to-remember manual that combines multiple fluoroscopic measurements to guide intraoperative decision making.  Large prospective studies of the "WRIST" protocol are needed for validation. But we believe that it may help surgeons to optimize surgical technique, functional and radiographic outcome, and prevent complications when treating distal radial fractures.