J Korean Soc Surg Hand.  2015 Jun;20(2):72-76. 10.12790/jkssh.2015.20.2.72.

Surgical Indications for Distal Radius Fractures

• Lee JH

• KMID: 2194103
• DOI: http://doi.org/10.12790/jkssh.2015.20.2.72

Abstract

In determining the treatment plan of distal radius fractures, the fracture type, stability, age, activity of patient may be concerned and radiologic parameters such as radial length, dorsal and volar tilt, radial inclination, joint incongruity have to be measured. In unstable distal radius fractures, secondary dislocation after primary closed reduction can be possible and a variety of factors affecting secondary displacement have been known, which are age, radial shortening, volar and dorsal cortical comminution et al. In general, the indications for surgical treatment are including step-off more than 2 mm, dorsal tilt more than 15degrees, radial inclination less than 15degrees, or radial shortening more than 5 mm.

Keyword

Distal radius fracture; Surgical indication

MeSH Terms

Dislocations
Humans
Joints
Radius Fractures*

Figure

• 

  Fig. 1. Radiographic parameters of the distal radius fracture. (A) Radial inclination. (B) Radial length. (C) Palmar tilt.’

• 

  Fig. 2. Treatment algorithm of displaced distal radius fractures. STS, sugar tong splint; SAC, short arm cast; R, removable.

Reference

References

1. Carrozzella J, Stern PJ. Treatment of comminuted distal radius fractures with pins and plaster. Hand Clin. 1988; 4:391–7.

2. Palmer AK, Werner FW. Biomechanics of the distal radioulnar joint. Clin Orthop Relat Res. 1984; (187):26–35.

3. Bronstein AJ, Trumble TE, Tencer AF. The effects of distal radius fracture malalignment on forearm rotation: a cadaveric study. J Hand Surg Am. 1997; 22:258–62.

4. Fernandez DL. Radial osteotomy and Bowers arthroplasty for malunited fractures of the distal end of the radius. J Bone Joint Surg Am. 1988; 70:1538–51.

5. Fernandez DL. Correction of post-traumatic wrist deformity in adults by osteotomy, bone-grafting, and internal fixation. J Bone Joint Surg Am. 1982; 64:1164–78.

6. Pogue DJ, Viegas SF, Patterson RM, et al. Effects of distal radius fracture malunion on wrist joint mechanics. J Hand Surg Am. 1990; 15:721–7.

7. Jenkins NH, Mintowt-Czyz WJ. Mal-union and dysfunction in Colles’ fracture. J Hand Surg Br. 1988; 13:291–3.

8. Adams BD. Effects of radial deformity on distal radioulnar joint mechanics. J Hand Surg Am. 1993; 18:492–8.

9. F af Ekenstam, CG Hagert, O Engkvist, AH Tornvall, H Wilbrand. Corrective osteotomy of malunited fractures of the distal end of the radius. Scand J Plast Reconstr Surg. 1985; 19:175–87.

10. Melone CP Jr. Articular fractures of the distal radius. Orthop Clin North Am. 1984; 15:217–36.

11. Miyake T, Hashizume H, Inoue H, Shi Q, Nagayama N. Malunited Colles’ fracture: analysis of stress distribution. J Hand Surg Br. 1994; 19:737–42.

12. Linscheid RL. Kinematic considerations of the wrist. Clin Orthop Relat Res. 1986; (202):27–39.

13. Kazuki K, Kusunoki M, Yamada J, Yasuda M, Shimazu A. Cineradiographic study of wrist motion after fracture of the distal radius. J Hand Surg Am. 1993; 18:41–6.

14. Amadio PC, Botte MJ. Treatment of malunion of the distal radius. Hand Clin. 1987; 3:541–61.

15. Fernandez DL. Malunion of the distal radius: current approach to management. Instr Course Lect. 1993; 42:99–113.

16. Leone J, Bhandari M, Adili A, McKenzie S, Moro JK, Dunlop RB. Predictors of early and late instability following conservative treatment of extra-articular distal radius fractures. Arch Orthop Trauma Surg. 2004; 124:38–41.

17. Altissimi M, Antenucci R, Fiacca C, Mancini GB. Longterm results of conservative treatment of fractures of the distal radius. Clin Orthop Relat Res. 1986; (206):202–10.

18. Graham TJ. Surgical correction of malunited fractures of the distal radius. J Am Acad Orthop Surg. 1997; 5:270–81.

19. Jupiter JB, Masem M. Reconstruction of post-traumatic deformity of the distal radius and ulna. Hand Clin. 1988; 4:377–90.

20. Knirk JL, Jupiter JB. Intra-articular fractures of the distal end of the radius in young adults. J Bone Joint Surg Am. 1986; 68:647–59.

21. Lafontaine M, Delince P, Hardy D, Simons M. Instability of fractures of the lower end of the radius: apropos of a series of 167 cases. Acta Orthop Belg. 1989; 55:203–16.

22. McQueen MM, Hajducka C, Court-Brown CM. Redisplaced unstable fractures of the distal radius: a prospective randomised comparison of four methods of treatment. J Bone Joint Surg Br. 1996; 78:404–9.

23. Nesbitt KS, Failla JM, Les C. Assessment of instability factors in adult distal radius fractures. J Hand Surg Am. 2004; 29:1128–38.