It is typically necessary for displaced intra-articular fractures with dorsal comminution. Dorsal plating is associated with extensor tendon irritation and rupture. Volar plating offers support to the subchondral bone to help maintain fracture reduction. Volar plating is associated with irritation of both flexor and extensor tendons, and flexor pollicus longus tendon rupture may have occurred. Open-reduction internal fixation with volar plating is much more common than dorsal plating. ![]() Good outcomes have been reported up to 90% of the time if used appropriately. It is essential to limit the duration of external fixation to a maximum of 8 weeks and to perform aggressive hand therapy to maintain range of motion of the hand. This technique relies on ligamentotaxis to maintain fracture reduction. External fixation is often used in conjunction with percutaneous pin or plate fixation as it does not reliably restore the volar tilt on its own. It is unacceptable when the volar cortex is comminuted, and therefore unstable, as there is not enough bony fixation to maintain reduction. ![]() Percutaneous pinning is useful in maintaining sagittal length and alignment in extra-articular fractures with a stable volar cortex. There are various methods of fixation, including pins, external fixators, dorsal plates, and a volar plate. The goal of surgical treatment is to achieve acceptable alignment and stable fixation for early motion. Non-displaced fractures are treated without surgery in a long-arm splint acutely and transitioned to a short-arm cast in the office for a total of 6 weeks with serial radiographs to monitor for fracture displacement and healing.įor fractures that do not meet acceptable alignment, surgical intervention is recommended. If the reduction is maintained, the splint may be converted to a cast and immobilized for a total of 6 weeks. If the reduction is not maintained and is no longer acceptable, surgical intervention should be recommended. If the fracture reduction meets the acceptable criteria, the patient may remain in the splint and follow up with an orthopedic surgeon where weekly radiographs will be obtained for the first 2 weeks. Post-reduction radiographs must be obtained to evaluate the quality of the reduction. The splint will allow for swelling as opposed to a cast. A long-arm, sugar-tong splint prevents pronation, supination, and elbow flexion, thereby eliminating the brachioradialis as a deforming force. Following the closed reduction, the arm should be immobilized in a long-arm, sugar-tong splint acutely, as opposed to a cast. Adequate anesthesia or analgesia, such as conscious sedation or hematoma block, are necessary for closed reduction. Volar tilt: Dorsal angulation less than 5 degrees or within 20 degrees of the contralateral distal radiusĭisplaced fractures must undergo a closed reduction in an attempt to achieve an anatomic or acceptable reduction. High-energy injuries may result in significantly displaced or highly comminuted unstable fractures to the distal radius. Cancellous impaction of the metaphysis compromises dorsal stability, and shearing forces impact the injury pattern, which often involves the articular surface. The relatively weaker, thinner dorsal bone collapses under compression whereas, the stronger volar bone fails under tension resulting in a characteristic “triangle” of bone comminution with the apex volar and greater comminution dorsal. This type of injury is often referred to as a "fall onto an outstretched hand" or FOOSH. This action places a dorsal bending moment across the distal radius. Most distal radius fractures result from falls with the wrist extended and pronated. ![]() The mechanism of injury in a distal radius fracture is an axial force across the wrist with the pattern of injury determined by bone density, the position of the wrist, and the magnitude and direction of the force.
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