The application of extensor retinaculum flap in the treatment of distal radius fracture with locking plate fixation through a dorsal approach

Objective To investigate the application and clinical outcomes of Z-shaped extensor retinaculum flap and extensor tendons superficial position in the treatment of distal radius fracture with locking plate fixation through a dorsal approach. Methods From December 2012 to March 2015, 23 cases of comminuted distal radius fractures were surgically treated by locking plate fixation, Z-shaped extensor retinaculum flap and extensor tendons superficial position. Dorsal locking plate was used in 18 cases, while dorsal and volar locking plate were used in 5 cases. The retinaculum was cut in a Z-shaped way and sutured to separate the extensor tendon from plate. The 3rd/4th or 2nd/3rd/4th compartment extensor tendons were placed above the flap. Follow-up evaluations included wrist radiography parameters before and after the surgery, wrist and finger range of active motion, grip strength, Gartland-Werley scoring system, DASH score and complications such as tendon rupture. Results Postoperative follow-up ranged from 7 to 34 months with an average of 14.4 months. Wrist radiography parameters after the surgery were significantly better than that before the surgery (P<0.05). Wrist and finger range of active motion were good according to Gartland-Werley scoring system, the overall satisfactory rate was 73.9%. DASH score was 18.3. No tendon rupture and bowstring deformity occurred. Conclusion After dorsal plate fixation, the application of Z-shaped extensor retinaculum flap to cover plate combined with extensor tendons superficial position can prevent tendon irritation or rupture, which will not cause the loss of wrist and finger range of motion or bowstring deformity. It was an effective method for the treatment of comminuted distal radius fractures. Key words: Radius fractures; Fracture fixation,internal; Dorsal approach; Extensor retinaculum