Clinical Faceoff: Controversies in the Management of Distal Radius Fractures.

Abstract

D istal radius fractures are among the most common fractures of the upper extremity, and account for approximately 20% of all fractures seen within the emergency room. The distal radius comprises of three articular surfaces, namely the scaphoid facet, lunate facet, and sigmoid notch. Treatment goals are centered on restoration of articular congruity, and where appropriate, early ROM with minimal complications to permit early functional recovery. Numerous fracture classifications exist which aim to define the fracture and guide treatment [1] (Fig. 1). Despite the frequency of these injuries, controversy exists about how best to manage them. The American Academy of Orthopaedic Surgeons practice guidelines on treatment of distal radius fractures recommend operative fixation for radial shortening greater than 3 mm, dorsal tilt greater than 10 from neutral, or intraarticular displacement greater than 2 mm [4]. To explore the controversies that are abound in terms of how to manage these injuries, it is my distinct pleasure to introduce two experts in the field of hand surgery. Ghazi Rayan MD is a Professor of Orthopaedic Surgery at University Oklahoma College of Medicine. Martin Boyer MD is the Jerome T. Loeb Professor of Orthopaedic Surgery at Washington University Medical School, St. Louis.