Indications for surgical management of distal radius fractures include intra-articular displacement greater than 2 mm, dorsal tilt greater than 10°, and radial shortening greater than 5 mm. The goal of surgical management is to restore coronal and sagittal plane alignment, rotation, and angulation.

This video presents a reproducible technique for restoring coronal plane alignment in patients with a distal radius metaphyseal fracture. The technique involves the use of an indirect reduction maneuver, leveraging the volar locking plate as a reduction aide. After applying an appropriately sized volar locking plate, the first screw is placed in the center of the oblong hole of the plate. Next, a variable angle guide is used to insert the distal row locking screws. The oblong hole screw is loosened, and two Freer elevators are used to rotate the plate to achieve anatomic coronal plane alignment. The oblong screw is tightened. Lastly, the remaining diaphyseal screw is applied in a bicortical fashion.