When an individual falls forward fall on pronated forearm with the hand and wrist in extension, bending of the metaphyseal bone because the weight of the body is transmitted along the long axis of the radius. Also the hard diaphyseal bone causes impaction of cancellous metaphyseal bone that result in metaphyseal collapse. During the fall, compressive forces over the dorsal cortex and tensile stress acting over the volar cortex result in volar and dorsal cortical bone disruption. When there is a supination of distal end of radius with respect of the radial diaphysis, a dorsal displacement fracture occurs. In about fifty to sixty percent of distal radiusfractures, associated ulnar styloid fractures. Also ulnar styloid fractures may be associated with triangular fibrocartilage disruption which may sometimes be an isolated finding.
From casting to arthroscopic assisted reduction, all treatment modalities have been tried. Sir Abraham Col- les first described the deformities of distal end radiusfractures many years before the advent of X-rays. Since then, a lot of modifications in the management of DRF have taken places, which include closed reduction with casting, percutaneous pinning, intrafocal pinning, external fixation with ligamentotaxis, minimal open to open reduction and internal fixation with various modern gadgets. Even the fragment specific fracture fixation has been tried with good results. Karimi et al. in his study has shown good results in torus fractures in patients less than 17 years of age using removable wrist splint. He, however, studied only the patients of less than 17 (16).Bahari-Kashani et al. (2003) studied the intra-articular distal end radiusfractures managed by pin and plaster or plating. They concluded that func- tional scoring, radiological indices, grip strength, and supination pronation were better in the plating group (17). Mardani et al. compared the closed reduction with long-arm cast to closed reduction with PCP and found the latter as better option in terms of finger stiffness, but found some pin tract infections, which resolved un- eventfully (18).
Fractures of distal radius are most common fractures of the upper extremity forming about 17 % of all fractures. Distal radial fractures have a bimodal age distribution, consisting of a younger patients sustaining injury due to relatively high-energy trauma and an elderly patients sustaining low energy trauma. Around 50-70 % of the distal radiusfractures are associated with distal ulna fractures following a rise in the high energy trauma in recent years. The treatment of distal radius fracture has seen a tremendous evolution from cast immobilization through Kirschner wire fixation to internal fixation with various plates. The significance of distal ulna fractures is often not appreciated and treated inadequately in comparison to its larger counterpart; the radius.
Distal radiusfractures (DRFs) are the most common type of fracture presented in hospitals, clinics, orthopaedic centers, and trauma practices all over the world. Thus, there is a very large body of literature on the many aspects of DRFs, particularly, nonsurgical and surgical treatment/management modalities. The present contribution has two focus areas. The first is a summary of many aspects of DRF on which there is controversy or inadequate coverage. As a consequence of this summary, the second focus is detailed expositions on opportunities for future work in nine areas. Results from some of this future work may aid selection of treatment/management modality for a specified patient-fracture pattern combination; for example, detailed cost-utility analyses of candidate modalities. Results from other future studies may translate to improved patient outcomes; for example, further studies on the photodynamic bone stabilization system for intramedullary fixation of fractures.
We report a case of an 80-year-old previously healthy Japanese female patient who was able to walk on her own. She fell down and was taken to our hospital. There were cut wounds measuring approximately 5 cm on the palmar side of both wrists (Figure 1A and B) and radiographs showed bilateral distal radiusfractures. The right side was classified as A3 according to the Arbeitsgemeinschaft für Osteosynthesefragen (AO) classification and the left side was A1 (Figure 2A,B,C and D). She was diagnosed with bilateral open distal radiusfractures and we performed
In total, 16 consecutive patients (Table 1) with displaced extra-articular distal radiusfractures (Fig. 1) and injured for more than 4 weeks were treated with mini-open wedge osteotomy (Fig. 2) and intramedullary fixation device (Micronail Ò , Wright Medical Technologies, Arlington, TN, USA), from July 2009 through February 2011 by a single surgeon. There were 5 men and 11 women, with an average age of 61.8 years (range 49–81 years). The fracture involved 5 right wrists and 11 left wrists in equal numbers of patients. According to the AO fracture classification , there were 10 AO type A2 and 6 AO type A3 frac- tures. The mechanisms of injury in all patients were either a simple fall on the outstretched hand or a traffic accident. The mean time from injury to surgery was 10.7 weeks (range 4–18 weeks). All patients had regular follow-up in our outpatient clinic for at least 12 months.
We assessed the error associated with radiographic inter- pretation of acute distal radiusfractures and whether the errors associated with measurements were small enough for measurements to be used confidently in fracture man- agement. We investigated the intra- and inter-observer re- liability of eight anatomic parameters in skeletally mature patients with an acute distal radius fracture using digitised radiographs. This investigation extends and updates the work of Kreder et al.  by using a larger sample of radio- graphs (30 acute fractures) and the computerised images and measurement procedures used in current practice. The majority of choices regarding treatment for distal ra- dius fractures occur in the acute period. This investigation utilized radiographs of acute distal radiusfractures in con- trast to the healed distal fracture radiographs utilized by Kreder et al. .
This study was reviewed and approved by our regional ethical review committee. Over a 12 month period, we treated 21 patients with complex type C distal radiusfractures using locked volar plating. Plating was under- taken by or under the supervision of one of two consul- tant orthopaedic surgeons with a specialist interest in upper limb surgery. Patients who were unfit for surgery, unable to give informed consent or who had low func- tional demands were not included. Fracture classifica- tion was performed preoperatively and confirmed at the time of surgery using the AO classification system . Post-operative assessment involved a wound check at 2 weeks with routine radiographic imaging, a further appointment at 6 weeks at which point formal referral for physiotherapy was made and another outpatient visit at 3 months. Patients were invited for a further clinical assessment at 6 months and all of the patients accepted this offer.
The purpose of this study was to analyze the clinical and radiologic outcomes of distal radiusfractures involving the intermediate column (C1, C2) and distal radius frac- tures (A1, A2) treated conservatively. The null hypothesis was that distal radiusfractures involving the intermediate column have a significantly poorer radiologic and clinical outcome. The analysis of the data supported the hypoth- esis. In this study, the ROM for pronation and supination revealed significant differences between the matched co- horts. It also suggested that distal radiusfractures involv- ing the intermediate column had a worse result in DASH scores. So far, there were few reports specialized on frac- tures of the intermediate column. This type of fracture was included in some other researches. From the view of the three-column theory, the die-punch fracture should be classified as the intermediate column fracture. In a study
Minimally displaced fractures of the distal radius are usu- ally treated non-operatively while displaced fractures are treated either with closed reduction and immobilization with cast, percutaneous pinning or external fixation or, especially when intraarticular, with open reduction and internal fixation. Recently, the use of internal fixation for displaced fractures, which is probably the most costly and technically demanding treatment method, has been widely increasing. Thus, estimating the incidence of frac- tures classified according to articular involvement and fracture displacement would be of importance in deter- mining costs and resource allocation for these injuries. Moreover, distal radiusfractures may result in prolonged pain and functional impairment . Complications such as persistent neuropathy of median, ulnar or radial nerve and fracture malunion have been reported in 1 out of 3 patients . In this respect, fracture severity charac- teristics may be of importance. Previous Scandinavian studies of fracture incidence presented the proportions of fractures classified according to the methods of Older and Frykman [4,6,13,14]. The AO system (Arbeitsgemein- schaft fur Osteosyntesfrage) of fracture classification is
Distal radiusfractures are one of the most common fractures, and biomechanical models are used to validate and develop novel treatment methods. Recent research suggests that the distal fracture fragment is smaller than observed in previous studies. Based on this data, an improved fracture model was developed. We were able to show that the biomechanical parameters assessed through biomechanical fracture models are sensitive to the position of the extra-articular comminuted fracture. The degree of sensitivity is dependent on the type of osteosynthetic device used. Consequently the fracture model introduced here should be used as the new gold standard for future research until more studies on fracture location have been done.
Our study has certain limitations. Certainly, the sam- ple size was limited and the overall follow-up was around 1 year. However, we feel that despite the limited number, our study is valuable for the following reasons: 1. It represents a single-surgeon experience for surgery and two experienced surgeons for follow-up. 2. In all pa- tients, we waited to submit the clinical result after com- pletion of physical functioning and return to work. In distal radiusfractures, this is achievable within 3 months after injury. 3. We were pleased with the radiolucency of the implant, allowing for proper assessment of healing in every X-ray on follow-up. In this respect, radius frac- tures differ from other injuries, such as tibial or femur shaft fractures.
Very few reports in the literature have studied the treatment of these complex fractures. The sample size of this study is not very large, but it is similar to previously reported series. Despite some points of weakness (inho- mogeneous samples with respect to the type of fracture, age and plates used), our study seems to demonstrate the effectiveness of volar long plating for treating distal radiusfractures that extend proximally to the radial diaphysis. Conflict of interest The authors declare that they have no conflict of interest related to the publication of this manuscript.
simple, minimally invasive technique to maintain the reduction in extra and intra articular fractures. Clinical guidelines from the American Academy of Orthopaedic Surgeons (AAOS) moderately recommend an anatomically stable surgical fixation, instead of cast fixation, to be followed by early wrist motion for treatment of patients with displaced distal radiusfractures. 4 Radial length is a radiological parameter that
In 1975 SARMIENTO introduced functional cast bracing to distal radiusfractures and immobilized the patient in supination. He modified the GARTLAND & WERLEY system of evaluation. The AO – ASIF group developed techniques of open reduction and internal fixation and external fixation. They applied their principles to distal radiusfractures like k wire pinning, plating and external fixators. They introduced AO minifixator for the distal radius.
Methods: Elbow radiographs images of patients with proximal radiusfractures were classified according to Mason, Morrey, and Arbeitsgemeinschaft für osteosynthesefragen/Association for the Study of Internal Fixation (AO/ASIF) classifications by four observers with different experience with this subject to assess their intra- and inter-observer agreement. Each observer analyzed the images on three different occasions on a computer with numerical sequence randomly altered.
Using the 3D modelling software ‘Wildfire Pro Engineer 4.0’ [Creo by PTC, Needham, MA] and with the help of a 7 year old male child the forearm as was replicated. Figure 1 shows the model of the forearm created on Wildfire Pro Engineer. The red circle indicates the mid shaft oblique fracture created onto the radius for our study. Figure 2 shows the forearm of the anatomical skeleton model. The black lines represent the exact section to which model was drawn at the radio humeral joint as alignment is affected the greatest after a fracture. This intersection was chosen as the point of analysis because of the slight translation of the radius during pronation and supination, as well as the misalignment that occurs; it is a crucial point to spot the collision of the two bones. Figure 3 shows the section closely.
fixation using the Stryker Matrix Volar Locking Plate (Stryker Leibinger GmbH & Co. Germany) between June 2004 and October 2007 treated in a single centre. Indications for surgery were displaced intra-articular fractures with post reduction articular step of > 2 mm; radial shortening of > 3 mm or > 15 degrees of saggital plane angulation (as measured from the anatomical volar tilted position). Additionally, fractures with fea- tures indicative of instability or poor outcome such as metaphyseal comminution and unsatisfactory radio-car- pal alignment were treated surgically . Finally, patients who originally underwent non-operative treat- ment in plaster but whose fracture displayed one of the above stated parameters for surgery at follow up, and underwent subsequent volar plate fixation were included. Exclusion criteria were fractures treated with alternative instrumentation, fractures over 4 weeks old at the time of surgery, and non-trauma operations such as corrective osteotomies.
Abstract: Background: Although operative fixation with a volar locking plate is becoming increasingly popular for treatment of distal radiusfractures, it is not clear whether it is superior to other conventional treatment methods such as percutaneous fixation with Kirschner wires. The present meta-analysis compared the effects of internal fixation with volar locking plates and percutaneous fixation for the treatment of distal radiusfractures. Methods: A literature search was performed without language restrictions and all randomized controlled studies comparing the effects of volar locking plates and percutaneous fixation for the treatment of distal radial fractures were included. Data of function scores, range of motion, grip strength, radiographic results, and complications were pooled and analyzed with a standard meta-analytical method. Results: Seven studies in seven publications were included. Pooled data indicated that there were no significant differences in Patient-Related Wrist Evaluation (PRWE) and Disabilities of the Arm, Shoulder, and Hand (DASH) scores between the two treatment methods postoperatively. Fixation with volar locking plates took significantly longer than percutaneous fixation. There was a significant differ- ence in supination and grip strength favoring volar locking plate fixation at 3 and 6 months but not at ≥12 months, postoperatively. The final complication rates were similar in the two treatment groups. Conclusion: In the manage- ment of distal radiusfractures, volar locking plate and percutaneous fixation yielded similar outcomes, while the former had the advantage of supination and grip strength in the early stage postoperatively. Percutaneous fixation was quicker to perform than volar locking plate fixation.
The fractures of the distal radius are very common injuries accounting for about 8 to 17% of fractures seen the emergency room. The purpose of this study was to evaluate functional and radiological outcome of patients with intra articular distal radiusfractures treated with a volar locking compression plate. As with an increase in life expectancy there is an increase in the incidence of these fractures as well. There appears to be a bimodal distribution among these fractures where the younger group falling prey due to high velocity injuries like road traffic accidents and the older group due to a trivial fall mainly due to senile osteoporosis. In terms of management