Revolutionizing the Fixation of Distal Radius Fractures

by Anup Patel, MD, MBA and Rajendra Sawh-Martinez, MD

Most academic plastic surgery training programs host visiting professors to foster the exchange of ideas. These are often internationally recognized experts who share their knowledge on broad array of topics ranging from pioneering research to operative techniques they have studied or developed. This past week our program had the wonderful opportunity to host Dr. Jorge Orbay, the innovator of the distal volar radius plate and founder of Skeletal Dynamics, to teach us about his journey from a Cuban immigrant to one of the leaders in management and fixation of distal radius fractures.

Dr. Orbay was born in Cuba before attending medical school at the University of Puerto Rico. Following this, he obtained an orthopedic residency slot at the Hospital of Joint Disease at the New York University. During this time, he developed a strong interest in hand surgery leading him to attain a fellowship at the University of Miami Hand and Microsurgery Program. His time at Jackson Memorial enabled him to witness a plethora of hand trauma including numerous distal radius fractures.

Many of these patients had their distal radius fractures fixated using K-wire pin or plate fixation via dorsal approaches with limited options. These difficult fracture repairs all too often experienced complications that were frustrating to Dr. Orbay, sparking his interest to pursue a new approach. Chastised and ridiculed for even considering repairing these injuries using a volar approach, he persisted exploring this revolutionary approach. Dr. Orbay partnered with engineers and used funds from his clinical practice to design a distal radius volar plate prototype. Measuring the biomechanics and applying his engineering background, Dr. Orbay created a plate that could withstand the stress and strain of a distal radius fracture in the laboratory setting.

AnupOrbay_blog

One late night, the ideal patient presented to the emergency room with a distal radius fracture amenable to receiving his newly developed volar plate. Dr. Orbay realized it was the time to see if his bench work could be transformed to the clinical setting. Much to his colleagues’ surprise, his patient did marvelously and healed without any complications. The case demonstrated that distal radius fractures could be appropriately treated from a volar approach and that Dr. Orbay’s plating system offered hand surgeons the way to do it (1).

Never one to remain complacent, Dr. Orbay pushed the envelope to see how he could continue improve the plate. During the time, he took the plate that he sold to DuPuy and split the plate to better address the scaphoid and lunate fossa. This plate made by his company Skeletal Dynamics continues to be a hit among hand surgeons who use it, and continues to evolve in Dr. Orbay’s hands.

Due to the countless hours put in by Bill Perugini, the Area Vice President of Skeletal Dynamics, and James Clune, our co-resident, a cadaver lab was established to allow Dr. Orbay himself to teach us how to use the plate. He spent three hours in the lab describing his extended volar approach to gain access to the distal radius (2).  He took us through the nuances of plating the radius with tricks he had learned to expedite the OR time in treating these often recalcitrant fractures. Our entire group learned a tremendous amount from him during this time period where we became more facile with treating distal radius fractures.

Our time with Dr. Orbay proved invaluable. It demonstrated the benefit of collaboration between orthopedic and plastic surgery hand surgeons, and the synergies that result. It exemplifies why hand and microsurgery programs that foster relationships between orthopaedic surgery and plastic surgery will train the best hand surgeons with the broadest scope of experience and perspectives. We welcome your thoughts to this blog and what you feel will help train all residents better in tackling hand and wrist injuries.

PlateEvoluation_web

Figures
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Figure 1: Dr. Orbay leading the Yale Plastic Surgery residents through a cadaver lab on fixating distal radius fractures.

Figure 2: Dr. Orbay showing Anup the plate that revolutionized the approach to plating distal radius fractures.

Figure 3: The evolution of the plates designed by Dr. Orbay over the years.

REFERENCES
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1. Volar fixed-angle plate fixation for unstable distal radius fractures in the elderly patient.
Orbay JL, Fernandez DL. J Hand Surg Am. 2004 Jan;29(1):96-102. PMID:14751111

2. The extended flexor carpi radialis approach: a new perspective for the distal radius fracture. Orbay JL, Badia A, Indriago IR, Infante A, Khouri RK, Gonzalez E, Fernandez DL.
Tech Hand Up Extrem Surg. 2001 Dec;5(4):204-11. No abstract available. PMID:16520583

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