Distal radius fracture surgery

Distal radius fracture Microchapters
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Rohan A. Bhimani, M.B.B.S., D.N.B., M.Ch.[2]

Surgery

Closed treatment is frequently unsuccessful in maintaining a good position in adults, because there is frequently comminution of the fracture. Re-displacement and deformity can reoccur with an unacceptable ultimate result.

CRITERION NORMAL ACCEPTABLE Ulnar variance (radial length) ±2 mm comparing level of lunate facet to ulnar head No more than 2 mm of shortening relative to ulnar head Radial height 12 mm ???? Palmar (lateral) tilt 11 degrees of volar tilt Neutral Radial inclination 20 degrees as measured from lunate facet to radial styloid No less than 10 degrees Intraarticular step or gap None Less than 2 mm of either

Incidence of Primary hyperparathyroidism according to race
Race	Gender (incidence per 100,000 person years)
	Women	Men
African-American	92	46
White	81	29
Asian	52	28
Hispanic	49	17
Other race	25	6

Contemporary surgical options have developed that really have revolutionized treatment of this common injury. Generally, techniques include Open Reduction Internal Fixation (ORIF), external fixation, percutaneous pinning, or some combination of the above. The greatest recent advances have been with operative open reduction and internal fixation ORIF. A entire market of surgical implants are available to treat this specific fracture. The two most recent and promising developments have been fragment specific fixation and fixed angle volar plating. These attempt fixation rigid enough to allow almost immediate mobility, thus ultimately less stiffness and greater function is possible. Although restoration of radiocarpal alignment is of obvious importance, one must not overlook the alignment of the distal radioulnar joint as this can be a source of a frustrating pronation contracture down the road.

Each orthopaedic surgeon will treat the fracture according to what his/her preferences are and what works best for him/her. The surgeon should be open to discussion of the rationality of the decisions that are made.

Prognosis varies depending on dozens of variables. If the anatomy (bony alignment)is not properly restored, function may remain poor even after healing. Restoration of bony alignment is not a guarantee of success, as there are significant soft tissue contributions to the healing process.

An arthroscope can be used at the time of fixation to evaluate for soft tissue injury. Structures at risk include the triangular fibrocartilage complex and the scapholunate ligament. Be ware of scapholunate injuries in radial styloid fractures where the fracture line exits distally at the scapholunate interval. TFCC injuries causing obvious DRUJ instability can be addressed at the time of fixation.