Abstract
A wide range of different classifications exist for distal radius fractures (DRF). Most of them are based on plane X-rays and do not give us any information on how to treat these fractures. A biomechanical understanding of the mechanical forces underlying each fracture type is important to treat each injury specifically and ensure the optimal choice for stabilization. The main cause of DRFs are forces acting on the carpus and the radius as well as the position of the wrist in relation to the radius. Reconstructing the mechanism of the injury gives insight into which structures are involved, such as ruptured ligaments, bone fragments as well as the dislocated osteoligamentous units. This article attempts to define certain key fragments, which seem crucial to reduce and stabilize each type of DRF. Once the definition is established, an ideal implant can be selected to sufficiently maintain reduction of these key fragments. Additionally, the perfect approach is selected. By applying the following principles, the surgeon may be assisted in choosing the ideal form of treatment approach and implant selection.
Highlights
The treatment options for distal radius fractures (DRF) have vastly improved over the years
This paper aims to provide a treatment-oriented concept for stabilizing DRFs based on a state-of-the-art fracture classification
The position of the wrist in relation to the radius plays an essential role in distal radius fractures
Summary
The treatment options for DRFs have vastly improved over the years. Beginning with conservative treatment including closed reduction and plaster casts [1,2,3,4,5,6,7,8], K-wires were the. It is only slightly depressed under the articular surface and overlooked, especially in plain X-rays If this central fragment is impacted deeper into the radius shaft, both the dorsal and palmar cortical bone, on which the stabilizing ligaments are attached, open up like a tulip (see Fig. 9a). The articular surface fractures with small fragments occur very far distally and include the palmar and dorsal ligamentous insertions These fragments are very difficult to stabilize, plates which can be placed very far distally are necessary. If stability cannot be achieved, an alternative such as spanning plates or external fixation should be used (see Fig. 22c, d) Approach Both dorsal and palmar approaches have to be used, depending on the dislocation and fragments of the fracture. The final/second treatment of DRF takes place under ideal circumstances
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