A proposed surgical strategy for complex articular distal radius fractures: The Marseille approach for radius salvage (MARS)

INTRODUCTION: Complex intra-articular distal radius fractures with severe comminution or fragment rotation may be difficult to reduce using conventional fixation. We describe a dorsal salvage strategy, the Marseille Approach for Radius Salvage (MARS), enabling direct articular visualization in selected cases. HYPOTHESIS: The MARS strategy allows reliable reduction and acceptable short-term functional outcomes in fractures not amenable to standard fixation. MATERIALS AND METHODS: Single-center prospective case series (May 2021-October 2025). CT assessed reduction quality (step-off ≤ 2 mm). Functional outcomes at 1 year included motion, grip strength, pain, and QuickDASH. RESULTS: Among 252 intra-articular fractures, 12 patients were included. All achieved satisfactory reduction on CT with maintenance at 6 months. At 1 year, pronosupination was preserved with mild extension loss and satisfactory pain and QuickDASH scores. One superficial infection and one mild tendon irritation requiring plate removal occurred; no tendon ruptures or CRPS were observed. DISCUSSION: The MARS strategy enables direct articular visualization and stable reconstruction and may be useful in fracture-dislocations or markedly rotated fragments where conventional techniques are challenging. CONCLUSION: MARS strategy represents a pragmatic salvage option for highly complex intra-articular distal radius fractures when conventional strategies are insufficient. LEVEL OF EVIDENCE: III; Prospective case series.