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Distal Radius Fractures
Updated: Sep 24 2021

Distal Radius Fracture Spanning External Fixator

Preoperative Patient Care
Operative Techniques

Preoperative Plan


Identify fracture characteristics

  • distal radius fracture pattern
  • bone quality
  • DRUJ disruption
  • amount of comminution
  • presence of intra-articular extension(s)


Execute surgical walkthrough

  • describe key steps of the procedure to the attending verbally prior to the start of the case
  • describe potential complications and steps to avoid them

Room Preparation


Surgical instrumentation

  • spanning external fixator set


Room setup and equipment

  • setup OR with standard operating table and radiolucent hand table
  • turn table 90° so that operative extremity points away from anesthesia machines
  • c-arm perpendicular to hand table with monitor in surgeon's direct line of site


Patient positioning

  • supine with shoulder at edge of bed centered at level of patient’s shoulder
  • hand centered on hand table, supinate arm
  • arm tourniquet placed on arm with webril underneath (optional)

Closed Reduction


Perform reduction

  • use manipulation with traction and countertraction
  • shake hand of the manipulated wrist and manipulate wrist using three point bending principles

Proximal Fixator Pins


Locate pin placement

  • identify radius 10cm proximal to the radial styloid
  • can also be at least 5cm outside the zone of injury
  • look for the bare area that is located in the palpable interval between the brachioradialis and the ECRL muscles


Make small incisions at pin sites

  • be sure to protect the branches of the superficial radial and lateral antebrachial cutaneous nerves
  • damage to these nerves can cause a painful neuroma


Place proximal pins at a 45 degree angle to the long axis of the arm

  • place pins in the dorsal radial to ulnar volar direction
  • visualize the periosteum
  • drill holes
  • place half pins
  • use a fixator clamp after the placement of the first half pin to determine the placement of the second half pin


Check the placement and depth of the pins with fluoroscopy


Distal Fixator Pins


Identify Pin Placement

  • identify the bare area over the proximal third of the second metacarpal
  • palpate the bare area between the the first dorsal interosseous muscle and the extensor tendon to the index finger
  • place both pins in the proximal 60% of the metacarpal
  • this is to avoid encroaching on the metacarpophalangeal joint capsule


Place half pins

  • place the 3 mm half pins in the center of the metacarpal shaft
  • insert the fixator clamp to guide the placement of the distal pin


Check pin placement with fluoroscopy

  • be sure the threads of the half pins are fully threaded in the far cortex

External Fixator Assembly


Close skin without tension

  • use 3-0 nylon to close skin


Apply rod connectors

  • apply pin to rod connectors
  • place clamps one fingerbreadth away from skin
  • make sure thumb and wrist motion are not blocked


Connect rods

  • connect rod proximally first
  • secure the rod distally
  • place second rod to increase stiffness of overall frame


Check reduction with fluoroscopy


Lock clamps in place


Perform a final tightening


Dress Pin Sites

  • place petroleum gauze and bulky dressing
Postoperative Patient Care
Private Note

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