282 H. Minegishi et al. Table I. Classiﬁcation of distal radius fractures according to the AO classiﬁcation system. Extra-articular, n = 1 Intra-articular, n = 14 A3 1 B 0 C1 3 C2 5 C3 6 ﬁbrocartilage complex (TFCC). Two important objectives in this technique are to insert correctly the locking pins just beneath the mechanically reliable subchondral bone and to reduce the fracture after ﬁxation of the epiphyseal fragments. The pronator quadratus was repaired with 3-0 absorbable sutures. The wrist was protected with a light below-elbow splint for 2 weeks, and physiother- apy with active and passive wrist and digital mobili- zation out of the splint was started immediately. Results The average follow-up period was 15.5 months (range 12–24 months). Artiﬁcial bone graft (tricalcium phos- phate chips) was performed for 6 patients. Overall, three patients exhibited complications: two patients had slight ﬁnger contraction, and one patient suffered an attrition rupture of the ﬂexor pollicis longus tendon, which was treated with tendon suture. There was no non-union or wound infection in this study. No breakage of plates was observed. Average preoperative, postoperative, and ﬁnal follow-up radiographic parameters are listed in Table II. Preoperative volar tilt was –9.3 ± 18.8 degrees (range –40 to 28 degrees), postoperative volar tilt was a recon- structed 10.1 ± 5.8 degrees (range 0 to 25 degrees), and ﬁnal follow-up volar tilt remained at 9.7 ± 5.0 degrees (range 3 to 23 degrees). Preoperative radial inclination was 14.1 ± 4.9 degrees (range 7 to 25 degrees), post- operative radial inclination was a reconstructed 19.3 ± 4.2 degrees (range 12 to 28 degrees), and ﬁnal follow- up radial inclination remained at 20.0 ± 4.2 degrees (range 12 to 28 degrees). Preoperative ulnar variance was 4.3 ± 2.3 mm (range 1 to 8.7 mm), postoperative ulnar variance was a reconstructed –0.5 ± 1.4 mm (range –2 to 2.9 mm), and ﬁnal follow-up ulnar variance remained at 0.2 ± 0.9 mm (range –1.7 to 2.4 mm). Average ﬁnal wrist range of motion was 55.5 ± 10.3 degrees extension (range 45 to 80 degrees) and 59.3 ± 17.5 degrees ﬂexion (range 50 to 90 degrees). Average ﬁnal forearm range of motion was 86.3 ± 17.2 degrees pronation (range 30 to 100) and 90.4 ± 5.9 degrees supination (range 80 to 100 degrees) (Table III). At ﬁnal functional assessment, the scores of 5 patients were excellent, 7 patients good, and 3 patients fair according to Cooney’s Clinical Scoring Chart (14). According to modiﬁcation using Saito’s valuation (15),14 patients were excellent and 1 was good. No patient experi- enced a change in daily activity or occupation. Discussion The primary goal in treatment of unstable fractures of the distal radius is to achieve proper reconstruction of the disrupted anatomy and allow the quick return of hand function without complications. Dorsal plate ﬁxation is biomechanically effective in buttressing a dorsally displaced fracture of the distal radius. Osada et al. compared the biomechanical properties of dorsal and volar fracture ﬁxation plate designs in a cadaver model (16). They reported that if the volarly placed titanium symmetry plate was used to ﬁx a Colles-type fracture, the distal fragment of the radius would develop a dorsal angulation of about 9 degrees if early active mobilization of the ﬁngers was initiated during the postoperative period. On the other hand, Leung et al. (8) demonstrated no statistical difference between axial loading transmission through the intact radius and a distal radius fracture ﬁxed with a volar locking plate. In fact, the volar locking plate showed advantages over dorsal plating in the ﬁxation of a dorsally unstable distal radius fracture. In addition, volar plate ﬁxation is a valuable method because of the decreased risk of inducing dorsal soft-tissue complications. The dorsal approach often needs dissection of the extensor retinaculum and sometimes resection of the Lister’s tubercle. There- fore, the extensor tendons are generally exposed to mechanical attrition by the plate and screws. In the volar approach, the volar anatomy of the wrist pre- sents an advantage over the dorsal aspect because there is more space between the volar cortex and the ﬂexor tendons. The pronator quadratus can also sometimes act as a hedge to prevent soft tissue complications. The palmar cortex is relatively ﬂat, Table II. Average (± SD) preoperative, postoperative, and ﬁnal follow-up radiograph parameters. Volar tilt, degrees Radial inclination, degrees Ulnar variance, mm Preoperative –9.3 ± 18.8 14.1 ± 4.9 4.3 ± 2.3 Postoperative 10.1 ± 5.8 19.3 ± 4.2 –0.5 ± 1.4 Final follow-up 9.7 ± 5.0 20.0 ± 4.2 0.2 ± 0.9