Improved ulnar plate positioning using the WHAM (Wrist Henry Approach Modification) for volar rim fixation of distal...

Fixation of small, very distal volar rim fragments of the distal radius is technically demanding because the classic Henry approach may provide limited ulnar exposure. The Wrist Henry Approach Modification (WHAM) combines a limited volar incision with a dual-window exposure.

The WHAM approach would enable more ulnar positioning of volar rim-specific plates than the classic Henry approach without increasing approach-related complications.

This retrospective single-center comparative study included 39 patients with distal radius fractures treated between June 2022 and March 2026 with a volar rim-specific hook plate and postoperative computed tomography (CT). Twenty underwent a classic Henry approach and 19 the WHAM approach. The primary outcome was the CT-measured distance between the most ulnar aspect of the plate and the ulnar border of the watershed line. Complications were also recorded.

Mean plate-to-ulnar-border distance was significantly lower with WHAM than with the classic Henry approach (3.8 ± 2.0 mm versus 5.9 ± 2.8 mm; p = 0.013), indicating more ulnar plate positioning. No implant extended beyond the ulnar border of the volar rim. Four complications occurred in the Henry group: one radial artery injury, one volar radiocarpal subluxation due to insufficient fixation, and two wound dehiscences. Two transient palmar cutaneous branch paresthesias occurred in the WHAM group. Overall complication rates did not differ significantly.

The WHAM approach was associated with significantly more ulnar CT-measured positioning of volar rim-specific plates than the classic Henry approach. No significant difference in complication rates was identified, although the study was not powered for this outcome. Whether this radiographic difference translates into improved fragment capture, fixation stability, or clinical outcomes remains to be determined.

III.