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Distal Radius Fracture

- Discussion:
    - fracture types:
- barton's fracture - dorsal
- barton's fracture - volar
- chauffeur's fracture
- colles fracture
- intra-articular fractures of distal radius
- pediatric distal radius fracture
- smith's fracture
- classification:
- frykman classification
- melone classification
- universal classification
- radiographs:
- radial inclination
- radial length
- palmar slope

Distal radial fractures are a common injury that have a bimodal age distribution. Younger patients with the injury can be further split into two groups, the paediatric low energy physeal type injuries or young adults with high energy injuries. The most common group by number however, are older osteoporotic adults in the over 60 age group, who are typically female patients.

Abraham Colles (1814) first described the dinner fork deformity of the dorsally displaced fracture of the distal radius and this eponym is regularly used. It should however be noted, that this is a clinical deformity diagnosis, as radiographs weren’t discovered until 1895 by Wilhelm Rontgen.

In terms of how to manage these injuries, my own surgical practice is informed by the results of the DRAFFT study and subsequent critical appraisal.

(Costa M et al. Percutaneous fixation with Kirschner wires versus volar locking plate fixation in adults with dorsally displaced fracture of the distal radius: randomised controlled trial. BMJ. 2014; Aug 5: 349.

Fullilove S, Gozzard C. Dorsally displaced fractures of the distal radius: a critical appraisal of the DRAFFT study. Bone Joint J. 2016: 98-B(3); 298-300).

In short, if a closed reduction can adequately restore the anatomy and K-wires can control that fracture pattern, then I offer an MUA & K-wiring. If this is not the case, then I use internal fixation or on occasion external fixation, depending upon the fracture, soft tissue and patient specific factors.

In addition there are particular groups of patients for whom I may offer a primary open reduction and internal fixation rather than considering manipulation and K-wiring. These are:

Those who require early hand function, to aid with weightbearing or return to work. Those who cannot tolerate a cast such as the cognitively impaired. Those who will not be able to return for removal of wires at 4 weeks.

Readers will find the following OrthOracle instructional techniques also of interest:

Distal Radius Fracture fixation , volar approach with Synthes® 2.4 mm Variable Angle locking LCP

Distal Radial fracture fixation with dorsal approach and Synthes 2.4mm variable angle plating system

Compound distal radius fracture: stabilised with Hoffman II External Fixator

Dorsal plating of distal radial fracture with Depuy/Synthes 2.4mm VA locking radial column plate assisted by wrist arthroscopy using Acumed ARC tower

Distal ulna fracture fixation using the Synthes 2mm LCP Distal Ulna Plate

Clinicians should seek clarification on whether any implant demonstrated is licensed for use in their own country.

In the USA contact: https://www.fda.gov/medical-devices/products-and-medical-procedures

In the UK contact:  https://www.gov.uk/government/organisations/medicines-and-healthcare-products-regulatory-agency

In the EU contact: https://www.ema.europa.eu/en/human-regulatory/overview/medical-devices 

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treatment options:
non operative treatment (closed reduction)
- percutaneous pinning
- external fixators for distal radius fractures:
- ORIF of distal radius fractures:

    - complications:
           - malunion
- references

THE TREATMENT OF DISTAL RADIUS FRACTURES GUIDELINE AND EVIDENCE REPORT (Summary of Recommendations)

A Systematic Review of Outcomes and Complications of Treating Unstable Distal Radius Fractures in the Elderly

- IM nail: (wright medical)
- requires initial & temporary intra focal pin fixation;
- dissection between the abductor pollicis longus/Ext Pollicis Brevis and the ECRL/ECRB
- references:
Prospective Study of Distal Radial Fractures Treated with an Intramedullary Nail 
- Comparative analysis of intramedullary nail fixation versus casting for treatment of distal radius fractures.
- A new technique in the treatment of distal radius fractures: the Micronail®.