The Extended Flexor Carpi Radialis Approach for Distal Radius Fracture Fixation: A Prospective Study
Bibliographic record
Abstract
Purpose The extended flexor carpi radialis (EFCR) approach for distal radius fractures and malunions was first described in 2001 by Orbay et al. This approach ensures optimal radial and dorsal exposure by releasing the radial septum and simplifies reduction by releasing deforming forces while providing access to the critical volar ulnar corner. We hypothesize the EFCR approach is safe and effective for routine use in the management of acute/subacute distal radius fractures without increased complication rates. Methods In total, 100 patients who underwent open reduction and internal fixation using an EFCR approach and a volar locking plate 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 scores, and complications. Volar tilt, radial inclination, ulnar variance and articular stepoff were measured after surgery. Descriptive statistics were used for analysis. Results The average follow-up period was 14 months with a mean Disabilities of Arm, Shoulder, and Hand 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 28 kg (±10). After surgery, the mean volar tilt was 7 o (±6), radial inclination 24 o (±4), and ulnar variance 0 mm (±1.6). Overall, the complication rate was 9%. There was one revision fixation for a periprosthetic fracture. Hardware removal was performed for plate-tendon irritation in 3% and patient preference in 2%. All other complications (3%) were minor and treated nonsurgically. Conclusions Our study supports the safety and effectiveness of the routine use of EFCR approach for acute/subacute operative distal radius fractures. It demonstrates excellent clinical, radiographic, and patient-reported outcomes. This series further supports its value in providing advantageous exposure and more efficient fracture reduction without increasing morbidity rates. Type of study/level of evidence Therapeutic IV.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".