Distal Radius Fracture Treated with a Modified Kocher-style Dorsolateral Approach, Distal Radius T-plate, and Cannulated Compression Screw Fixation

Abstract

Distal radius fractures are common injuries and displaced or unstable patterns frequently require operative stabilization. Volar locking plating remains the predominant method for many unstable distal radius fractures; however, selected radial column or radial styloid-dominant patterns may be amenable to fragment-specific fixation. We report a displaced distal radius fracture treated using a modified Kocher-style dorsolateral wrist exposure with cannulated compression screw fixation augmented by a distal radius T-plate. A 45-year-old, right-hand-dominant, male manual laborer presented after a fall on an outstretched hand with acute right wrist pain, swelling, deformity, and painful restriction of wrist motion. Radiographs and computed tomography evaluation showed a displaced extra-articular distal radius fracture with a dominant radial styloid/lateral fragment, minimal comminution, intact ulna, and congruent distal radioulnar joint. Open reduction and internal fixation was performed through a 5-cm dorsolateral modified Kocher-style approach. The fracture was anatomically reduced, buttressed with a distal radius T-plate, and compressed using a 3.0-mm cannulated compression screw placed from the radial styloid across the fracture line under fluoroscopic guidance. The postoperative course was uneventful. At 6 weeks, radiographs showed early callus and maintained alignment, with approximately 60° of active wrist flexion and 60° of extension without pain. At 3 months, radiographs showed union with trabecular bridging, clinically symmetrical wrist range of motion, grip strength comparable to the contralateral side, and return to manual work. At 1-year follow-up, the patient remained asymptomatic without tendon irritation, neurovascular deficit, implant prominence, loss of reduction, or need for implant removal. This case suggests that, in carefully selected distal radius fractures with a large radial styloid/radial column fragment and limited comminution, a modified Kocher-style dorsolateral approach with cannulated compression screw fixation and T-plate augmentation may provide stable reduction while avoiding a standard volar exposure. This technique is not proposed as a replacement for volar locking plating; rather, it may be considered as a selected alternative when fracture morphology permits direct fragment-specific compression and buttress support. The single-case design and absence of prospectively recorded patient-reported outcome scores limit generalizability.