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Open Reduction and Internal Fixation of the Distal Radius With a Volar Locking Plate
Healthy, active patients with an unstable fracture of the distal radius are considered for open reduction and internal fixation (ORIF) with a volar locking plate. Instability is defined as inadequate alignment after manipulative reduction, loss of adequate alignment after manipulative reduction, or a high likelihood of healing with inadequate alignment with cast immobilization alone. The likelihood of losing alignment has been related to several factors, including initial fracture displacement, comminution, and age and functional level (both likely related to osteoporosis).1,2 Adequate alignment is variably and somewhat arbitrarily defined as more than 10° to 20° of dorsal tilt of the articular surface on a lateral view, more than 3 to 5 mm of ulnar positive variance, and a 2 mm or greater articular step or gap.2
