Indications:

• Distal radius fractures (AO/OTA Types 23-A, B, C)
• Volar shearing fractures (Barton's fractures)
• Unstable extra-articular and intra-articular fractures
• Fracture malunions or nonunions requiring corrective osteotomy

Contraindications:

• Active local or systemic infection
• Severe osteopenia where fixation may be compromised (relative)
• Medial column (distal ulna) fractures requiring alternative fixation
• Skeletally immature patients

1. Imaging: PA, lateral, and oblique radiographs. CT scan recommended for intra-articular fractures.
2. Templating: Use radiographic template to select plate size and side. Confirm plate's distal curvature matches the volar rim.
3. Equipment: Ensure availability of VA plating system, K-wires, reduction clamps, and fluoroscopy (C-arm).

Step 1: Patient Positioning - Position patient supine with arm on a radiolucent hand table. Apply tourniquet.

Step 2: Surgical Approach - Modified Henry Approach via FCR tendon sheath incision. Protect radial artery and elevate pronator quadratus (PQ).

Step 3: Fracture Reduction - Achieve anatomic reduction before plate application. Use joystick K-wires and Freer elevators for manipulation.

Step 4: Plate Positioning - Place plate flush with the watershed line. Do not place too distally to avoid tendon irritation.

Step 5: Provisional Fixation - Secure plate to shaft with a non-locking screw in the proximal oblong hole to allow adjustments.

Step 6: Distal Fixation - Insert 2.4mm or 2.7mm locking screws into subchondral bone. Typically 3-5 distal screws are used.

Step 7: Proximal Fixation - Place at least three bicortical screws in the proximal shaft segment.

Step 8: Final Check - Verify reduction under fluoroscopy and assess DRUJ stability.

Step 9: Closure - Repair PQ back over the plate to protect flexor tendons. Standard skin closure.

• 2 Weeks: Suture removal, transition to removable splint, gentle ROM.
• 6 Weeks: Discontinue splint, begin progressive strengthening.
• 12 Weeks: Full union typically expected.

Disclaimer: This technique guide is for educational purposes only. Specific steps and protocols must be tailored to individual patient and fracture patterns.