Management of Metadiaphyseal Proximal Radius Fractures

Abstract

Metadiaphyseal proximal radius fractures blur the distinction between the radial neck and radial shaft fractures. Operative management presents unique technical challenges both in terms of surgical approach and fixation method. We discuss relevant anatomy, safe surgical approach, and options and techniques for fracture fixation. We describe 6 patients who achieved satisfactory functional outcomes, even in cases of severe bone loss secondary to ballistic trauma. An extensile dorsal approach with exposure of the posterior interosseous nerve is recommended when normal soft tissue intervals have not already been extensively disrupted. Robust fixation can be achieved by contouring and repurposing a variety of plates such as a variety of mini fragment plates (2.4 mm T or Y-plates), flexible nails, or even distal radius plates.

Pediatric Radial Neck Fractures: A Systematic Review Regarding the Influence of Fracture Treatment on Elbow Function

“…A small incision (<3 cm) is recommended [ 20 ], the annular ligament should be preserved, and instruments that could damage the radial head during reduction should be avoided. The use of a “Joy stick” K-wire in the proximal fragment to aid fracture reduction is favored over the use of clamps to prevent potential damage to the posterior interosseous nerve (PIN) [ 69 ].…”

Metadiaphyseal proximal radial fracture around the bicipital tuberosity fixed using a volar distal ulna plate via the volar Henry approach: a case report

“…Precontoured radial head plates and plates intended for the radial diaphysis can be difficult to apply to the anatomy of the metadiaphyseal proximal radius in a manner that satisfactorily restores the native anatomy, preserves prono-supination, and provides sufficient fixation proximal and distal to the fracture. 5 In this report, we describe a rare case of proximal radial fracture in which good postoperative results were achieved.…”

“…Fractures of the proximal radial metadiaphysis are relatively uncommon. 5 Only a few cases of isolated fractures around bicipital tuberosity have been reported. 5 , 7 Available treatment methods for radial head/neck and diaphyseal fractures may be difficult to apply to fractures of the metadiaphyseal proximal radius.…”

“… 5 Only a few cases of isolated fractures around bicipital tuberosity have been reported. 5 , 7 Available treatment methods for radial head/neck and diaphyseal fractures may be difficult to apply to fractures of the metadiaphyseal proximal radius. The morphology of the bone, its articulation with the ulna, nearby neurovascular structures, and the origins and insertions of various muscles limit safe surgical exposure as well as the application of an implant.…”

Dorsal Thompson: Approach to the Proximal Radial Shaft

“…1 Operative fixation is indicated if the patient experiences mechanical blocks to motion or radiographic fracture displacement that alters the biomechanics of either radioulnar joint. 2 Fixation of forearm fractures is unique in that success depends on preserving the articulation of the radius around the ulna, thus restoring anatomic forearm geometry, and the treatment of choice is often plated osteosynthesis. 3 To adequately mobilize the fracture fragments during reduction and plate placement, an extensive surgical approach is typically required.…”