The palmar intra-articular extended window approach for distal radial fractures: a biomechanical cadaveric study

A palmar intra-articular extended window approach can be used during surgical treatment of intra-articular fractures of the distal radius. A biomechanical study was carried out on 10 fresh-frozen cadaver wrists to measure the impact of the approach on proximal carpal row stability during simulated grip loading. The null hypothesis was that this approach would not generate a displacement of more than 2 mm of the scaphoid or lunate in any direction. After incising the palmar capsule, no significant increase in ulnar translation of the lunate or scaphoid was observed. However, after additionally releasing the dorsal radiocarpal ligament, increased mobility was observed, mainly in the anteroposterior axis. This approach may be suitable for the treatment of intra-articular fractures of the distal radius without causing carpal instability. However, care should be taken when there is a suspicion of dorsal wrist ligament injury. Level of evidence: Level V.