The Extended Flexor Carpi Radialis Approach for Distal Radius Fracture Fixation: A Prospective Study

The extended flexor carpi radialis (EFCR) approach for unstable distal radius fractures (DRF) and malunions was first described in 2001 by Orbay et al. This approach ensures optimal radial, dorsal and distal exposure by releasing the radial septum and simplifies reduction by releasing primary deforming forces while providing access to the critical volar ulnar corner. This study presents a case series of 100 patients with prospectively collected clinical, radiographic and patient-reported outcomes. We hypothesize the EFCR approach is a safe and effective technique for routine use in the surgical management of acute/subacute DRFs without increased complication rates. 100 patients who underwent open reduction and internal fixation (ORIF) using an EFCR approach and volar locking plate (VLP) between 2018 and 2023 were included. A retrospective review of prospectively collected data was conducted including wrist range of motion, grip strength, Disabilities of Arm Shoulder and Hand (DASH) scores and complications. Volar tilt, radial inclination, ulnar variance and articular step off were measured postoperatively. Descriptive statistics including mean, median, standard deviation, minimum and maximum for each were calculated. The average follow-up period was 14 months with a mean DASH score of 6.8 at the final visit. The mean wrist range of motion was: 72° (±11) flexion, 60° (±11) extension, 78° (±8) supination, 77° (±6) pronation. The mean grip strength was 27 kg (±10). Postoperatively, the mean volar tilt was 7o (±6), radial inclination 24o (±4), and ulnar variance 0 mm (±1.6). Overall, the complication rate was 9%. There was one revision fixation for a periprosthetic fracture proximal to the existing construct. Hardware removal was performed for symptomatic plate-tendon irritation in 3%, and patient preference in 2%. All other complications (3%) were minor and treated nonsurgically. Our study supports the safety and effectiveness of the routine use of EFCR approach for all acute/subacute operative DRFs. It demonstrates excellent clinical, radiographic, and patient-reported outcomes. This case series further supports its value in providing advantageous exposure and more efficient fracture reduction without increasing morbidity rates.