J Korean Orthop Assoc.  2013 Apr;48(2):165-174. 10.4055/jkoa.2013.48.2.165.

Complications of Distal Radius Fracture

Affiliations
  • 1Department of Orthopedic Surgery, College of Medicine, Korea University, Seoul, Korea. ospark@korea.ac.kr

Abstract

Fracture of the distal radius is one of the most common fractures encountered in the emergency room. Although selection of a proper treatment modality is important for successful management of this fracture, early detection, prevention, and adequate treatment for its complications is also important. Complications associated with fracture of the distal radius can occur at any time during the treatment process and the prevalence rate is up to 27% of all distal radius fractures. This article provides a review of possible complications associated with distal radius fracture, along with a discussion of prevention and appropriate treatment methods.

Keyword

distal radius fracture; complication

MeSH Terms

Emergencies
Prevalence
Radius
Radius Fractures

Figure

  • Figure 1 In cases of extensor pollicislongus tendon rupture after volar plate fixation (A, B), transfer of the extensor indicisproprius can restore thumb function (C).

  • Figure 2 Volar distal radius plate fixed distal to the watershed line (A; arrow) can irritate the overlying flexor tendons and delayed tendon rupture can occur (B).

  • Figure 3 Delayed carpal tunnel syndrome can be caused by malunited distal radius fracture (arrow).

  • Figure 4 The proximal pins of the external fixator may injure the superficial radial nerve (A, B). After neuroma excision (C), the vein graft is applied for reconstruction of the nerve defect (D).

  • Figure 5 Intra-articular screw protrusion can result in severe intra-articular injury (arrow).

  • Figure 6 In case of a typical malunited distal radius fracture (A), radial shortening, loss of volar tilting and radial inclination, and dorsal subluxation of the ulnar head can limit forearm rotation (B).

  • Figure 7 Pin-site infection can be treated with local wound care and oral or intravenous antibiotics, or local debridement in addition to pin removal.


Cited by  1 articles

Comparison of Skyline View and Intraoperative Computed Tomography for Detecting Protruded Screws during Volar Plating of Distal Radius Fractures
Kyeong Hoon Lim, Hong Je Kang
Arch Hand Microsurg. 2019;24(2):112-119.    doi: 10.12790/ahm.2019.24.2.112.


Reference

1. Turner RG, Faber KJ, Athwal GS. Complications of distal radius fractures. Hand Clin. 2010. 26:85–96.
Article
2. McKay SD, MacDermid JC, Roth JH, Richards RS. Assessment of complications of distal radius fractures and development of a complication checklist. J Hand Surg Am. 2001. 26:916–922.
Article
3. Atkins RM. Complex regional pain syndrome. J Bone Joint Surg Br. 2003. 85:1100–1106.
Article
4. Yu YR, Makhni MC, Tabrizi S, Rozental TD, Mundanthanam G, Day CS. Complications of low-profile dorsal versus volar locking plates in the distal radius: a comparative study. J Hand Surg Am. 2011. 36:1135–1141.
Article
5. Schnur DP, Chang B. Extensor tendon rupture after internal fixation of a distal radius fracture using a dorsally placed AO/ASIF titanium pi plate Arbeitsgemeinschaft für Osteosynthesefragen/Association for the Study of Internal Fixation. Ann Plast Surg. 2000. 44:564–566.
6. Rhee PC, Dennison DG, Kakar S. Avoiding and treating perioperative complications of distal radius fractures. Hand Clin. 2012. 28:185–198.
Article
7. Bonatz E, Kramer TD, Masear VR. Rupture of the extensor pollicis longus tendon. Am J Orthop (Belle Mead NJ). 1996. 25:118–122.
8. Ring D, Jupiter JB, Brennwald J, Büchler U, Hastings H 2nd. Prospective multicenter trial of a plate for dorsal fixation of distal radius fractures. J Hand Surg Am. 1997. 22:777–784.
Article
9. Rozental TD, Beredjiklian PK, Bozentka DJ. Functional outcome and complications following two types of dorsal plating for unstable fractures of the distal part of the radius. J Bone Joint Surg Am. 2003. 85:1956–1960.
Article
10. Althausen PL, Szabo RM. Coverage of distal radius internal fixation and wrist fusion devices with AlloDerm. Tech Hand Up Extrem Surg. 2004. 8:266–268.
Article
11. Benson EC, DeCarvalho A, Mikola EA, Veitch JM, Moneim MS. Two potential causes of EPL rupture after distal radius volar plate fixation. Clin Orthop Relat Res. 2006. 451:218–222.
Article
12. Matullo KS, Dennison DG. Lateral tilt wrist radiograph using the contralateral hand to position the wrist after volar plating of distal radius fractures. J Hand Surg Am. 2010. 35:900–904.
Article
13. Riddick AP, Hickey B, White SP. Accuracy of the skyline view for detecting dorsal cortical penetration during volar distal radius fixation. J Hand Surg Eur Vol. 2012. 37:407–411.
Article
14. Soong M, Got C, Katarincic J, Akelman E. Fluoroscopic evaluation of intra-articular screw placement during locked volar plating of the distal radius: a cadaveric study. J Hand Surg Am. 2008. 33:1720–1723.
Article
15. Gelb RI. Tendon transfer for rupture of the extensor pollicis longus. Hand Clin. 1995. 11:411–422.
Article
16. Odumala O, Ayekoloye C, Packer G. Prophylactic carpal tunnel decompression during buttress plating of the distal radius--is it justified? Injury. 2001. 32:577–579.
Article
17. Soong M, Earp BE, Bishop G, Leung A, Blazar P. Volar locking plate implant prominence and flexor tendon rupture. J Bone Joint Surg Am. 2011. 93:328–335.
Article
18. Arora R, Lutz M, Hennerbichler A, Krappinger D, Espen D, Gabl M. Complications following internal fixation of unstable distal radius fracture with a palmar locking-plate. J Orthop Trauma. 2007. 21:316–322.
Article
19. Casaletto JA, Machin D, Leung R, Brown DJ. Flexor pollicis longus tendon ruptures after palmar plate fixation of fractures of the distal radius. J Hand Surg Eur Vol. 2009. 34:471–474.
Article
20. Brown EN, Lifchez SD. Flexor pollicis longus tendon rupture after volar plating of a distal radius fracture: pronator quadratus plate coverage may not adequately protect tendons. Eplasty. 2011. 11:e43.
21. Posner MA. Flexor superficialis tendon transfers to the thumb--an alternative to the free tendon graft for treatment of chronic injuries within the digital sheath. J Hand Surg Am. 1983. 8:876–881.
Article
22. Dyer G, Lozano-Calderon S, Gannon C, Baratz M, Ring D. Predictors of acute carpal tunnel syndrome associated with fracture of the distal radius. J Hand Surg Am. 2008. 33:1309–1313.
Article
23. Szabo RM. Acute carpal tunnel syndrome. Hand Clin. 1998. 14:419–429.
Article
24. Brüske J, Niedźwiedź Z, Bednarski M, Zyluk A. Acute carpal tunnel syndrome after distal radius fractures--long term results of surgical treatment with decompression and external fixator application. Chir Narzadow Ruchu Ortop Pol. 2002. 67:47–53.
25. Ford DJ, Ali MS. Acute carpal tunnel syndrome. Complications of delayed decompression. J Bone Joint Surg Br. 1986. 68:758–759.
Article
26. Nourbakhsh A, Tan V. Median nerve fibrosis at the distal forearm after volar plate fixation of distal radius fracture. J Hand Surg Eur Vol. 2010. 35:768–769.
Article
27. Kongsholm J, Olerud C. Carpal tunnel pressure in the acute phase after Colles' fracture. Arch Orthop Trauma Surg. 1986. 105:183–186.
Article
28. Gelberman RH, Szabo RM, Mortensen WW. Carpal tunnel pressures and wrist position in patients with colles' fractures. J Trauma. 1984. 24:747–749.
Article
29. Lee HC, Wong YS, Chan BK, Low CO. Fixation of distal radius fractures using AO titanium volar distal radius plate. Hand Surg. 2003. 8:7–15.
Article
30. Korcek L, Wongworawat M. Evaluation of the safe zone for percutaneous Kirschner-wire placement in the distal radius: cadaveric study. Clin Anat. 2011. 24:1005–1009.
Article
31. Steinberg BD, Plancher KD, Idler RS. Percutaneous Kirschner wire fixation through the snuff box: an anatomic study. J Hand Surg Am. 1995. 20:57–62.
Article
32. Hassan DM, Johnston GH. Safety of the limited open technique of bone-transfixing threaded-pin placement for external fixation of distal radial fractures: a cadaver study. Can J Surg. 1999. 42:363–365.
33. Soong M, Ring D. Ulnar nerve palsy associated with fracture of the distal radius. J Orthop Trauma. 2007. 21:113–116.
Article
34. Puna R, Poon P. The anatomy of the dorsal cutaneous branch of the ulnar nerve. J Hand Surg Eur Vol. 2010. 35:583–585.
Article
35. Lundy DW, Quisling SG, Lourie GM, Feiner CM, Lins RE. Tilted lateral radiographs in the evaluation of intra-articular distal radius fractures. J Hand Surg Am. 1999. 24:249–256.
Article
36. Maschke SD, Evans PJ, Schub D, Drake R, Lawton JN. Radiographic evaluation of dorsal screw penetration after volar fixed-angle plating of the distal radius: a cadaveric study. Hand (N Y). 2007. 2:144–150.
Article
37. Smith DW, Henry MH. The 45 degrees pronated oblique view for volar fixed-angle plating of distal radius fractures. J Hand Surg Am. 2004. 29:703–706.
38. Orbay JL, Fernandez DL. Volar fixed-angle plate fixation for unstable distal radius fractures in the elderly patient. J Hand Surg Am. 2004. 29:96–102.
Article
39. Schumer ED, Leslie BM. Fragment-specific fixation of distal radius fractures using the Trimed device. Tech Hand Up Extrem Surg. 2005. 9:74–83.
Article
40. Patel VP, Paksima N. Complications of distal radius fracture fixation. Bull NYU Hosp Jt Dis. 2010. 68:112–118.
41. Drobetz H, Kutscha-Lissberg E. Osteosynthesis of distal radial fractures with a volar locking screw plate system. Int Orthop. 2003. 27:1–6.
Article
42. Orbay JL, Touhami A. Current concepts in volar fixed-angle fixation of unstable distal radius fractures. Clin Orthop Relat Res. 2006. 445:58–67.
Article
43. Handoll HH, Watts AC. Bone grafts and bone substitutes for treating distal radial fractures in adults. Cochrane Database Syst Rev. 2008. 2:CD006836.
Article
44. Jakubietz MG, Gruenert JG, Jakubietz RG. The use of beta-tricalcium phosphate bone graft substitute in dorsally plated, comminuted distal radius fractures. J Orthop Surg Res. 2011. 6:24.
Article
45. Werber KD, Raeder F, Brauer RB, Weiss S. External fixation of distal radial fractures: four compared with five pins: a randomized prospective study. J Bone Joint Surg Am. 2003. 85:660–666.
46. Boyer MI, Korcek KJ, Gelberman RH, Gilula LA, Ditsios K, Evanoff BA. Anatomic tilt x-rays of the distal radius: an ex vivo analysis of surgical fixation. J Hand Surg Am. 2004. 29:116–122.
Article
47. Wiesler ER, Chloros GD, Mahirogullari M, Kuzma GR. Arthroscopic management of distal radius fractures. J Hand Surg Am. 2006. 31:1516–1526.
Article
48. Chapman DR, Bennett JB, Bryan WJ, Tullos HS. Complications of distal radial fractures: pins and plaster treatment. J Hand Surg Am. 1982. 7:509–512.
Article
49. Ahlborg HG, Josefsson PO. Pin-tract complications in external fixation of fractures of the distal radius. Acta Orthop Scand. 1999. 70:116–118.
Article
50. Hargreaves DG, Drew SJ, Eckersley R. Kirschner wire pin tract infection rates: a randomized controlled trial between percutaneous and buried wires. J Hand Surg Br. 2004. 29:374–376.
Article
51. Egol KA, Paksima N, Puopolo S, Klugman J, Hiebert R, Koval KJ. Treatment of external fixation pins about the wrist: a prospective, randomized trial. J Bone Joint Surg Am. 2006. 88:349–354.
52. Glueck DA, Charoglu CP, Lawton JN. Factors associated with infection following open distal radius fractures. Hand (N Y). 2009. 4:330–334.
Article
53. Rozental TD, Beredjiklian PK, Steinberg DR, Bozentka DJ. Open fractures of the distal radius. J Hand Surg Am. 2002. 27:77–85.
Article
54. McQueen MM, Gaston P, Court-Brown CM. Acute compartment syndrome. Who is at risk? J Bone Joint Surg Br. 2000. 82:200–203.
55. Hwang RW, de Witte PB, Ring D. Compartment syndrome associated with distal radial fracture and ipsilateral elbow injury. J Bone Joint Surg Am. 2009. 91:642–645.
Article
56. Zyluk A. Complex regional pain syndrome type I. Risk factors, prevention and risk of recurrence. J Hand Surg Br. 2004. 29:334–337.
Article
57. Amadio PC. Vitamin C reduced the incidence of reflex sympathetic dystrophy after wrist fracture. J Bone Joint Surg Am. 2000. 82:873.
Article
58. Lichtman DM, Bindra RR, Boyer MI, et al. Treatment of distal radius fractures. J Am Acad Orthop Surg. 2010. 18:180–189.
Article
59. Shah AS, Verma MK, Jebson PJ. Use of oral vitamin C after fractures of the distal radius. J Hand Surg Am. 2009. 34:1736–1738.
Article
Full Text Links
  • JKOA
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr