Operative Treatment of Distal Radius Fractures

Abstract

the incidence of distal radius fractures is increasing together with the average age of population. intra-articular incongruity is the most probable cause of unsatisfactory outcome of distal radius fractures in younger and more active patients. thus, the main goal in the treatment of distal radius fractures should be restoration of articular congruence. acomputed tomography (ct) is recommended to help surgeon in preoperative planning in the treatment of comminuted intra-articular fractures. new implants have been designed to provide stable enough fixation fore arly mobilisation after surgery and to lower rather high complication rates related to conventional fixation methods such as external fixation and dorsal plating. the most common complications related to volar fixed angle plating such as flexor and extensor tendon problems, median nerve neuropathy,and screw diplacement into the radiocarpal joint are surgeon related and are avoidable with proper education. more randomized prospective studies are needed to prove superiority of any fixation method to another.Key words: Distal radius; fracture; operative treatment; plating; external fixation; malpractice; complications FaCtors aFFeCting outCome therei ss till some controversy about the factors affecting the outcome of distal radius fractures. Persistent intra-articular incongruity has been shown to cause a9,9-fold increased risk of radiological osteoarthritis and restriction of range of motion (rom) (7, 8). seventy-six to 91% of fractures of young adults with residual intra-articular incongruity showed arthritis 7y ears after the injury compared to 11%o f fractures with congruous joint (9, 10). Forwardetal. (7) reported that after 38 years follow up grade 0or1 arthritic changes weref ound in 65% of wrists after intra-articular fractures, grade 2i n3 0% and grade 3 in 5% of fractures. However,o steoarthritic changes do nota lways worsen the functional end result (8,11). Dorsal angulation of radiocarpal joint surface worsens functional outcome considerably when it exceeds 20 degrees (12, 13). thirty-eight years after the injury each ten degrees of dorsal angulation diminishes volar flexion by three degrees (7). Dorsal angulation exceeding 20 degrees caused a6a nd 8 degrees loss of volar flexion 30 and 7years after the injury (14, 15)respectively. radial shortening of more than 4mmassociates with decreased forearm rotation scandinavian Journal of surgery 97:

Type C distal radial fractures treated with conventional AO plates: an easy and cost-saving solution in a locking plate era

“…With patients sustaining distal radius fractures the shift to an operative treatment is most striking [2][3][4][5][6]. Although literature has identified predictors for instability and malunion, it does not provide robust evidence for which patients are eligible for surgery [7,8].…”

Comparison between Distractor Application on Both Radial & Ulnar Side and Radial Side Only for Fracture Distal Radius with Ulnar Styloid Fracture

“…Distal radius fracture along with involvement of the ulnar styloid, closed or open, can be treated by distractor application on the radial side only. It can also be treated by application of distractor on both the radial and ulnar sides of the affected forearm [3]. Hence we conducted a study in our rural set up to compare the results of treatment of these fractures by external fixation with a distractor by either of the two methods.…”

The Unstable Distal Radius Fracture—How Do We Define It? A Systematic Review

“…10,33,40,42,43,[60][61][62][63][64][65] The most frequently used classification system to describe an unstable distal radius fracture was the AO classification (8%, 18/213). 23,[66][67][68][69][70][71][72][73][74][75][76][77][78][79][80][81][82] An AO type C2 was the fifth most commonly mentioned description used to define an unstable distal radius fracture (5%, 10/213). 66,67,[70][71][72][73][74]79,81,82 In 4% (9/213) of the studies, the description according to Poigenfürst (radioulnar separation; the presence of dorsal comminution, and an associated ulnar fracture) was used.…”