The Extended Flexor Carpi Radialis Approach for Distal Radius Fracture Fixation: A Prospective Study.

PURPOSE: The extended flexor carpi radialis (EFCR) approach for distal radius fractures and malunions was first described in 2001 by Orbay et al. This approach ensures optimal radial and dorsal exposure by releasing the radial septum and simplifies reduction by releasing deforming forces while providing access to the critical volar ulnar corner. We hypothesize the EFCR approach is safe and effective for routine use in the management of acute/subacute distal radius fractures without increased complication rates.

METHODS

In total, 100 patients who underwent open reduction and internal fixation using an EFCR approach and a volar locking plate between 2018 and 2023 were included. A retrospective review of prospectively collected data was conducted including wrist range of motion, grip strength, Disabilities of Arm, Shoulder, and Hand scores, and complications. Volar tilt, radial inclination, ulnar variance and articular stepoff were measured after surgery. Descriptive statistics were used for analysis.

RESULTS

The average follow-up period was 14 months with a mean Disabilities of Arm, Shoulder, and Hand score of 6.8 at the final visit. The mean wrist range of motion was 72° (±11) flexion, 60° (±11) extension, 78° (±8) supination, 77° (±6) pronation. The mean grip strength was 28 kg (±10). After surgery, the mean volar tilt was 7o (±6), radial inclination 24o (±4), and ulnar variance 0 mm (±1.6). Overall, the complication rate was 9%. There was one revision fixation for a periprosthetic fracture. Hardware removal was performed for plate-tendon irritation in 3% and patient preference in 2%. All other complications (3%) were minor and treated nonsurgically.

CONCLUSIONS

Our study supports the safety and effectiveness of the routine use of EFCR approach for acute/subacute operative distal radius fractures. It demonstrates excellent clinical, radiographic, and patient-reported outcomes. This series further supports its value in providing advantageous exposure and more efficient fracture reduction without increasing morbidity rates.

TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.