Scar and short-term outcomes after transverse versus modified Henry incisions for volar plating of selected distal radius fractures: a retrospective comparative study

Background Volar locking plate fixation is widely used for distal radius fractures (DRFs), but visible scarring and incision-related morbidity remain important patient-centred concerns. This exploratory retrospective study compared scar outcomes and selected short-term clinical outcomes between a single palmar lateral transverse incision and the modified Henry approach in surgically treated DRFs selected for limited volar exposure. Methods This retrospective comparative study included 77 of 86 potentially eligible patients with DRFs who underwent volar locking plate fixation between January 2016 and December 2024; nine patients were excluded because of loss to follow-up and/or incomplete outcome data. Thirty-two patients were treated through a single transverse incision, and 45 through the modified Henry approach. Outcomes included tourniquet time, incision length, Lidström radiographic grade, DASH score, POSAS at final follow-up, and complications. Analyses were unadjusted, and Holm correction was applied across seven outcome comparisons. Results No transverse-incision procedure required incision extension or conversion to the modified Henry approach, and no major complication occurred. No statistically significant between-group differences were observed in follow-up duration, tourniquet time, dichotomised Lidström grade, or DASH score (all unadjusted P > 0.05). The transverse-incision group had shorter incisions ( P < 0.001; Holm-adjusted P < 0.007) and lower PSAS scores ( P = 0.002; Holm-adjusted P = 0.012). The OSAS difference was significant before, but not after, multiplicity correction (unadjusted P = 0.032; Holm-adjusted P = 0.160). Conclusions In this selected cohort, the transverse incision was associated with shorter incisions and lower patient-reported scar scores. The observer-reported scar difference did not remain significant after multiplicity correction. These findings suggest that the transverse incision may offer a scar-related advantage in appropriately selected fractures. The retrospective design and differences in fracture complexity warrant cautious interpretation and prospective confirmation.