Prospective two-center case series by Orbay and Fernandez evaluating a novel volar fixed-angle plate (DVR plate) with subchondral support pegs for dorsally displaced unstable distal radius fractures. The core question: can a volar approach achieve anatomic reduction and durable fixation while avoiding the extensor tendon problems that limited dorsal plating? This is the foundational clinical report that launched modern volar locking plate surgery for distal radius fractures.
Dorsal plating for distal radius fractures was the operative standard before this paper, but extensor tendon irritation, attrition, and rupture were well-recognized complications — a direct consequence of the thin soft tissue envelope between extensor tendons and the dorsal cortex.
Orbay's key insight was anatomic: the pronator quadratus physically separates a volar plate from the flexor tendons, and preserving dorsal periosteum during a volar approach keeps the blood supply to comminuted dorsal fragments intact.
In practice, this means you approach nearly all unstable dorsally displaced distal radius fractures from the volar (FCR) side. When you see persistent deformity of ≥15° angulation, ≥2 mm articular displacement, or ≥2 mm shortening after closed reduction, this is the operation.
Know the contraindications: dorsal Barton fractures, massively comminuted joint surfaces (>5 articular fragments), fractures into the distal radial shaft, and skeletally immature patients are not candidates for this technique.
This paper directly enabled every modern volar locking plate system (Synthes volar LCP, Aptus, and others) and precipitated the worldwide shift away from dorsal plating and external fixation that defines current distal radius fracture management.
Prospective two-center case series by Orbay and Fernandez evaluating a novel volar fixed-angle plate (DVR plate) with subchondral support pegs for dorsally displaced unstable distal radius fractures. The core question: can a volar approach achieve anatomic reduction and durable fixation while avoiding the extensor tendon problems that limited dorsal plating? This is the foundational clinical report that launched modern volar locking plate surgery for distal radius fractures.
Dorsal plating for distal radius fractures was the operative standard before this paper, but extensor tendon irritation, attrition, and rupture were well-recognized complications — a direct consequence of the thin soft tissue envelope between extensor tendons and the dorsal cortex.
Orbay's key insight was anatomic: the pronator quadratus physically separates a volar plate from the flexor tendons, and preserving dorsal periosteum during a volar approach keeps the blood supply to comminuted dorsal fragments intact.
In practice, this means you approach nearly all unstable dorsally displaced distal radius fractures from the volar (FCR) side. When you see persistent deformity of ≥15° angulation, ≥2 mm articular displacement, or ≥2 mm shortening after closed reduction, this is the operation.
Know the contraindications: dorsal Barton fractures, massively comminuted joint surfaces (>5 articular fragments), fractures into the distal radial shaft, and skeletally immature patients are not candidates for this technique.
This paper directly enabled every modern volar locking plate system (Synthes volar LCP, Aptus, and others) and precipitated the worldwide shift away from dorsal plating and external fixation that defines current distal radius fracture management.