Management of High Energy Distal Radius Injuries

Abstract

Purpose of Review High energy distal radius are commonly multi-fragmentary with significant comminution and/or bone loss. They can also be associated with ligamentous and soft tissue injury and neurovascular compromise. As such, reconstruction of these injuries can be challenging. This paper will review the relevant anatomy, different methods of fixation, and present techniques for difficult fractures. Recent Findings Volar locked plating is a successful, very common method of treatment for distal radius fractures, but dorsal plating, fragment specific fixation, spanning bridge plating, and external fixation are sometimes necessary, particularly in higher energy injuries characterized by metaphyseal comminution, small volar fragments, intra-articular free fragments or lunate facet subsidence. Extended flexor carpi radialis (FCR), dorsal, and flexor carpi ulnaris (FCU) exposures can assist in visualizing the fracture site. Summary There are many different modes of fixation for distal radius fractures, and successful outcome depends on selection of appropriate fixation based on the fracture pattern and status of the soft tissues. Keywords Distal radius. Hand trauma. Comminuted fracture. Articular fracture. Open reduction internal fixation This article is part of the Topical Collection on Distal Radius and Wrist Fractures

Management of Distal Radius Fractures: Comparison of Three Methods

“…VLP method has numerous functional and structural advantages, including its anatomically shaped design, early mobilization, and well-preserved wrist function. Several reports show that the VLP is related to tendon related complications, even necessitating plate removal and resurgery [8].However, we did not experience such complications in our patient group, possibly as a result of appropriate patient selection, careful soft tissue dissection and precise screw lengths. Farhan et al reported in their series of patients with AO23C3 distal radius fractures that 16% of the patients required plate removal [23].…”

“…Yu et al reported a 34.5% and 28.2% complication rate in their patients treated with EF and VLP, respectively [13]. The most common complications for surgical management of distal radius fractures include loss of reduction, infection, joint stiffness due to nerve injury, tendon rupture, osteoarthritis, and tendonitis [8,21,22].…”

“…The patient's age, occupation, familiarity of the procedure to the surgeon, the comorbidities such as tendon and median nerve injuries should be taken into account, as well as the fracture configuration [ 5 - 7 ]. Internal fixation with VLP is the most commonly used treatment for unstable distal radius fractures despite its relatively higher complication rate due to deep dissection of soft tissue around the fracture region, and the need for a removal surgery for intra-articular fracture cases [ 8 ]. On the other hand, closed reduction techniques EF and K-wire have the advantages of being less invasive with easy application and lower costs [ 9 ].…”

Primary Open Reduction and Plate Fixation in Open Comminuted Intra-Articular Distal Radius Fracture

“…[1][2][3][4] Although most DRF management strategies involve nonoperative methods, a significant trend toward surgical treatment has been noted, 5,6) largely explained by the introduction of volar locking plate (VLP) fixation, which is associated with advantages such as stable fixation, short immobilization period, and few complications. [7][8][9] In open DRFs, there is no consensus regarding operative treatment modalities, and the effectiveness of surgical fixation and its timing have been controversial and are based on the surgeon's preference. 10,11) Infection after open DRFs is a primary concern for determining the appropriate treatment methods.…”

Control of pain in the early post-traumatic period in the outpatient practice. Results of the multi-center observational study RAPTOR (Rational Analgesia PostTraumatic: an Observational Research)

“…Смещение отломков кости при недостаточно адекватной репозиции, стойкий отек, повреждение мышц и тендинит сухожилия сгибателей пальцев могут стать причиной повреждения нервов (прежде всего, срединного) с развитием характерной симптоматики -нарушения чувствительности, невропатической боли, синдрома запястного канала, КРБС. По литературным данным, такие осложнения отмечаются в 2-8% случаев после перелома ЛК [45,46].…”