Distal radial fractures are common problems for the orthopedic surgeon, and various surgical treatments have been reported. However, each method has its indications, pitfalls, and limitations. It is important to select the appropriate procedure for the fracture pattern. We studied 115 consecutive patients including 45 patients with distal radial fractures treated with percutaneous pinning, 67 patients treated with external fixation, and 32 patients treated with assisted wrist arthroscopy. Percutaneous pinning was useful in extra-articular fractures and minimally comminuted intra-articular fractures, but was inadequate for patients with severe osteopenia and markedly comminuted intra-articular fractures. External fixation was indicated when intra-articular comminution was present. However, the dorsomedial fragment was often not reduced and maintained by this technique; additional pinning was needed to reduce this fragment. A dynamic-type fixator was feasible for younger patients who required early functional recovery. Arthroscopy provided accurate visualization of the wrist joint and the intra-articular fracture.

In a 4-year period, 17 consecutive patients with posttraumatic chronic regional pain syndrome were treated with a new technique, Movelat manipulation therapy. At average follow-up of 8 months, satisfactory results were achieved in 15 patients (88%), but 2 patients, 1 with digital nerve injury and 1 with ulnar nerve injury, did not respond to the therapy. Factors associated with good clinical response include chronic regional pain syndrome type I, i.e., dystrophy produced by a trauma to the hand but not involving a specific nerve injury, early-stage disease (within 3 months after trauma), and involvement of the upper limbs. Complications were rare and mild (pain over the tourniquet site in 3%, temporary dizziness in 1%). This therapy is simple and safe and recommended for early treatment of chronic regional pain syndrome.

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