Distal radius fractures are the most common fractures in the upper extremity. If indicated, surgical fixation often is performed with the use of a precontoured volar locking plate. This video presents an extended flexor carpi radialis approach for exposure, mobilization, and reduction of distal radius fractures. Previous literature on this technique is reviewed, and the authors' rationale for the routine use of this approach is discussed. A clinical case presentation is reviewed, and technical pearls of surgical management are discussed. The video also reviews the results of a case series performed by a single surgeon at our tertiary referral center.

Between 2018 and 2020, 48 patients underwent fixation of a distal radius fracture via an extended flexor carpi radialis approach. The mean patient age was 50 years (range, 18 to 82 years), and approximately 70% of the patients were female. The mean time to surgery was 19.3 days. The mean follow-up was 14 months. Patients had acceptable radiographic outcomes with respect to volar tilt (8° ± 6.7°), radial inclination (24°± 4.1°), and ulnar variance (0.5 mm ± 2 mm). At final follow-up, no delayed unions, nonunions, wound healing complications, infections, tendon ruptures, or hardware removal were reported. One patient underwent revision surgery for the management of a secondary periprosthetic fracture. Transient tendon irritation occurred in four patients, none of whom required treatment. Two patients had persistent pain and were treated for presumed complex regional pain syndrome.

Our case series suggests that the extended flexor carpi radialis approach is an effective approach for the management of distal radius fractures, facilitating excellent visualization and reduction, acceptable radiographic outcomes, and a low rate of complications.