ABSTRACT

Aim: To evaluate the safety of the modified direct lateral approach in patients with proximal 3rd fracture of the radius treated with a 3.5mm AO dynamic compression plate.

Methods: This prospective case series was done using a non-probability consecutive sampling technique at the Department of Orthopedic Surgery and Traumatology, King Edward Medical University/ Mayo Hospital, Lahore, from March 2015 to November 2018. We enrolled 40 patients age between 18 to 70 years with closed displaced extra-articular fracture proximal 1/3rd of radius without elbow instability. Patients with radial nerve injury, pathological fracture, and previous injury of the affected arm were excluded. We recorded side of the injury, duration of surgery, post-operative posterior interosseous nerve injury (Extension of thumb and metacarpophalangeal joint) and superficial branch of radial nerve injury (sensory loss of area of nerve distribution), hematoma formation, infection, implant failure, resisted supination and pronation clinically and radiological union using radiographic union scale (RUST) criteria and functional outcome using Quick DASH score till last follow-up.

Results: Out of the total 40 patients, the mean age was 42±10.85year. There were 27(63%) males, and 13(37%) were female patients. Right side were 23(57.5%) and left side were 17(42.5%) patients. The mean duration of surgery was 21±7.12 mins. None of the patients had postoperative posterior interosseous nerve injury and superficial branch of radial Nerve. Only 01(2.5%) patients had hematoma formation. Superficial infection was noted in 01 (2.5%) patients. There was no case of implant failure. Union was achieved in all cases till the last follow-up. The mean post-operative Quick DASH score, 12th, 24th, and 36th week was 51.7±12.01, 36.2±10.57, and 10.2±8.6, respectively. The resisted supination and pronation were normal in all cases.

Conclusion: The modified direct lateral approach is safe for proximal 3rd radius fractures treated with a dynamic compression plate without nerve injury, less hematoma, and infection with the excellent union and functional outcome.

Keywords: Modified Direct Lateral Approach, Direct Lateral Approach, Proximal Radius