Ye YY, Shen ZQ, Wu CL, Lin YB. Minimally invasive plate osteosynthesis for distal radius fractures using a 3-point positioning technique. World J Orthop 2025; 16(7): 107913 [DOI: 10.5312/wjo.v16.i7.107913]
Corresponding Author of This Article
Yan-Bin Lin, Department of Traumatic Orthopaedics, Fuzhou Second General Hospital, No. 47 Shangteng Road, Cangshan District, Fuzhou 350007, Fujian Province, China. 746001548@qq.com
Research Domain of This Article
Orthopedics
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Orthop. Jul 18, 2025; 16(7): 107913 Published online Jul 18, 2025. doi: 10.5312/wjo.v16.i7.107913
Minimally invasive plate osteosynthesis for distal radius fractures using a 3-point positioning technique
You-You Ye, Zhao-Qing Shen, Chun-Ling Wu, Yan-Bin Lin
You-You Ye, Chun-Ling Wu, Yan-Bin Lin, Department of Traumatic Orthopaedics, Fuzhou Second General Hospital, Fuzhou 350007, Fujian Province, China
Zhao-Qing Shen, Department of Traumatic Orthopaedics, The Third Hospital of Zhangzhou, Zhangzhou 363000, Fujian Province, China
Author contributions: Ye YY, Lin YB, Shen ZQ, Wu CL designed the research study; Ye YY, Lin YB performed the research; Shen ZQ and Wu CL contributed new reagents and analytic tools; Ye YY, Lin YB, Shen ZQ analyzed the data and wrote the manuscript. All authors have read and approve the final manuscript.
Supported by Fujian Provincial Clinical Medical Research Center for First Aid and Rehabilitation in Orthopaedic Trauma, No. 2020Y2014; and Fuzhou Health Technology Innovation Platform Construction Project, No. 2019-S-wp2.
Institutional review board statement: Ethical approval was obtained from the Medical Ethics Review Committee of the Fuzhou Second General Hospital, The Third Clinical Medical College, Fujian Medical University (Approval No. 2023101).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare that they have no competing financial interests.
Data sharing statement:
Data not available to be shared.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yan-Bin Lin, Department of Traumatic Orthopaedics, Fuzhou Second General Hospital, No. 47 Shangteng Road, Cangshan District, Fuzhou 350007, Fujian Province, China. 746001548@qq.com
Received: April 7, 2025 Revised: April 30, 2025 Accepted: June 17, 2025 Published online: July 18, 2025 Processing time: 103 Days and 11.7 Hours
Abstract
BACKGROUND
The volar approach with plate fixation is the gold standard for treating distal radius fractures, often requiring incision of the pronator quadratus (PQ) muscle. Preserving the PQ during surgery may facilitate early postoperative recovery. However, conventional minimally invasive plate osteosynthesis (MIPO) techniques frequently necessitate multiple (3-4) intraoperative fluoroscopic adjustments to achieve optimal plate positioning, which can inadvertently damage the PQ muscle. Based on our clinical observations, we developed a novel 3-point positioning technique to minimize PQ injury while ensuring accurate plate placement. Preliminary results demonstrate promising early clinical outcomes.
AIM
To retrospectively analyze distal radius fractures treated using the 3-point positioning-assisted MIPO technique with preservation of the PQ.
METHODS
The 3-point positioning technique was applied: The Kirschner wire was inserted after fluoroscopy and was correctly adjusted the position of the plate above the PQ. With the aid of Kirschner wires positioning the PQ stripping was performed only once, and the plate then placed in a correct and satisfactory position. Operation time, incision length, wrist pain score, upper extremity function disabilities of the arm, shoulder and hand (DASH) score, wrist Gartland-Werley score, wrist grip strength, and range of motion were among the quantitative variables recorded. Qualitative variables including AO fracture classification, intraoperative and postoperative complications were evaluated.
RESULTS
At a mean follow-up of 6.9 ± 0.8 months, the mean scar length was 25.4 ± 1.5 mm, the pain score was 0.7 ± 0.6, the DASH score for the upper limb was 4.7 ± 1.3, and the Gartland-Werley score for wrist function was 4.1 ± 1.1 at the last follow-up. Mean flexion was 97.3%, extension was 97.0%, pronation was 98.9%, supination was 98.9%, and grip strength was 86.6% compared to contralateral values. No unfavorable intraoperative or postoperative complications occurred.
CONCLUSION
The 3-point positioning technique may reduce the damage to the PQ muscle and is a safe and effective method for MIPO for distal radius fractures.
Core Tip: This study introduces an innovative 3-point positioning technique for distal radius fracture fixation using minimally invasive plate osteosynthesis (MIPO). Under fluoroscopic guidance, Kirschner wires were strategically placed to achieve precise plate positioning above the pronator quadratus (PQ) muscle. This technique reduces PQ dissection to a single surgical maneuver, avoiding the repetitive plate adjustments required in conventional MIPO that may compromise PQ integrity. By optimizing plate placement efficiency, our method demonstrated improved PQ preservation and superior early clinical outcomes compared to traditional approaches.
