Executive Editor: Steve Krikler

Authors: Renato Fricker, Jesse Jupiter, Matej Kastelec

Distal forearm Extraarticular fracture of the radius with volar displacement or tilt

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1 Preliminary remarks top


Fracture assessment and decision making

In these fractures, the distal fragment is displaced in a palmar direction. These are often referred to as Goyrand or Smith fractures. Due to the pull of the flexor tendons, the fragment tends to redisplace after closed reduction.
The treatment of choice, therefore, is palmar buttress plating.


Palmar plate

Advances in plate design have provided angular stable fixation. This allows enhanced stability and ease of application, even in the presence of osteoporotic bone. Plates with variable angle locking screw options may be useful.

2 Patient preparation and approach top


Patient preparation

This procedure is normally performed with the patient in a supine position for palmar approaches.



There are two palmar surgical approaches to the distal radius – a modified Henry approach to the radius and a more ulnar approach, designed to expose the median nerve as well as the distal radius.

A thorough knowledge of the anatomy around the wrist is essential. Read more about the anatomy of the distal forearm.

3 Reduction top


Reduce the fracture using the following steps:

  1. Increase palmar angulation to disimpact
  2. With traction applied, in association with distal pressure on the metaphyseal fragment, extend the hand and wrist
  3. Final anatomical reduction can be achieved by direct manipulation, using a dental pick or similar hook.


A smooth K-wire is placed through the radial styloid across the fracture site into the opposite radial cortex to secure the reduction.


Pitfall: Over reduction

Care must be taken not to over reduce the distal fragment and create a dorsal displacement of the distal fragment.  After confirmation of reduction under image intensification, the distal fragment should always be secured with plate and screws.

4 Plate fixation top


Plate insertion

Apply the plate to the bone. The distal end of the plate should end at the anatomic watershed zone of the distal radius.

Insert a screw into the oblong plate hole in the proximal radial fragment. Select a screw which is long enough to engage both cortices.

Before fully tightening it, check the plate position using intraoperative imaging, adjusting the position of the plate as necessary.


The initial distal screw should be placed through the ulnar sided screw holes.

The reason for this is that if the initial screw is placed on the radial side it will block accurate imaging of the ulnar screw placement. 


A sagittal image is obtained with the angle of the X-ray beam directed 20° obliquely to the radius to control that the screw is not penetrating the radial carpal joint.


Insert remaining screws

Insert at least 3 distal locking head screws.

Then insert at least two more proximal screws.

Remove the K-wire.