Technique Spotlight

TL;DR: In this article , the key steps, pearls, and pitfalls of the dorsal approach to open treatment of distal radial fractures are discussed, as well as the benefits and drawbacks of the approach.

Abstract: Management of distal radial fractures through a dorsal approach is a useful tool in the treatment of fractures requiring operative treatment. With the advent of volar locked plating, the role of dorsal plating has diminished over the recent past. However, certain fracture patterns may be better addressed with dorsal plating including dorsal shear fractures, very distal and comminuted fragility fractures, dorsal die-punch fractures, or fractures with concomitant carpal injuries. Newer low-profile plates and locking technology have significantly improved the shortfalls of the early-generation dorsal plates, specifically tendon irritation and rupture. Biomechanical and clinical studies of dorsal plating have found comparable strength, radiographic outcomes, and clinical results when compared to other fixation methods. The treatment of distal radius fractures with low-profile dorsal plating systems is a safe and effective method that provides stable internal fixation, and are especially good options for particular fractures that have proved challenging for volar locked plating. This chapter outlines the key steps, pearls, and pitfalls of the dorsal approach to open treatment of distal radial fractures.