Distal radius fracture-tactic and approach

Abstract

The aim of surgical treatment is fracture healing with restored alignment, rotation, and joint surface. Stable fixation allows for functional postoperative aftercare. Displaced intra- and extra-articular fractures which either could not be adequately reduced or in which asecondary displacement is to expected due to instability criteria. The following factors are considered instability criteria: age > 60years, female, initial dorsal displacement > 20°, dorsal comminution, radial shortening > 5 mm, palmar displacement. The only absolute contraindication is if the patient is deemed unfit for surgery due to concerns regarding anesthesia. Old age is arelative contraindication, as it is currently debated whether older patients benefit from the operation. The surgical technique is guided by the fracture pattern. Palmar plating is most commonly performed. If the joint surface needs to be visualized, adorsal approach (in combination with another approach or alone) or arthroscopically assisted fixation should be chosen. In general, afunctional postoperative regime can be carried out after plate fixation with mobilization without weightbearing. Short-term splinting can provide pain relief. Concomitant ligamentous injuries and fixations, which are not stable enough for functional aftercare (such as k‑wires) require alonger period of immobilization. Provided the fracture is reduced correctly, osteosynthesis improves functional outcome. The complication rate ranges between 9 and 15% with the most common complication being tendon irritation/rupture and plate removal. Whether surgical treatment holds the same benefits for patients > 65years as for younger patients is currently under debate.