Indications, surgical approach, reduction, and stabilization techniques of distal radius fractures

Self Cite

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.

Section: Introductionmentioning

confidence: 99%

Biomechanical considerations on a CT-based treatment-oriented classification in radius fractures

Hintringer¹,

Rosenauer

Pezzei

et al. 2020

Self Cite

“…The anatomy of the distal radius in the sagittal view will reveal the etiology of ulnar impaction syndrome and help distinguish between a shortening of the radius with or without loss of the palmar inclination. This is of great importance when deciding between operative therapies with either an ulnar shortening or radius corrective osteotomy [1,11,23,33,35]. Magnetic resonance imaging (MRI) may reveal bone marrow edema in the proximal-ulnar corner of the lunate and a central TFCC lesion/perforation, ulnar chondromalacia as well as a LT ligament tear (Fig.…”

Section: Radiological Examinationmentioning

confidence: 99%

Ulnar shortening osteotomy as a treatment of symptomatic ulnar impaction syndrome after malunited distal radius fractures

Terzis

Koehler

Sebald

et al. 2020

A malunited distal radius fracture can lead to symptomatic ulnar impaction syndrome, which is a common cause for ulnarsided wrist pain. If conservative treatment fails and symptoms persist after an arthroscopic ulnocarpal debridement, ulnar shortening osteotomy (USO) is the treatment of choice. Since the first USO described by Milch in 1941 after a malunited Colles fracture, many techniques have been described varying in surgical approach, type of osteotomy and osteosynthesis material used. Many studies demonstrated good to very good functional results after USO, reporting, however, a delayed union or non-union rate up to 18%. A modern, low profile, locking plate showed in our short-term study very good functional results and no implant-associated complications, in particular no non-union.

“…The plate is fixed through its gliding hole in the diaphysis to ensure a more distal or proximal plate position. Additional K-wires can be inserted distally to stabilize the reduced intra-articular fragments [32].…”

Section: Assisted Fracture Reductionmentioning

confidence: 99%

Arthroscopic assisted treatment of distal radius fractures and concomitant injuries

Kastenberger

Kaiser

Schmidle

et al. 2020

Wrist arthroscopy is mainly used to assist fracture reduction and fixation and to diagnose and treat concomitant injuries mainly to the scapholunate (SL), lunotriquetral (LT) ligament and the triangular fibrocartilage complex (TFCC). Arthroscopy is beneficial in improving anatomical reduction of fracture steps and gaps in intra-articular distal radius fractures (DRFs). Yet, the literature that the functional outcome correlates with the use of arthroscopy, is limited. Non-surgical treatment and immobilization is recommended for Geissler grade I-III Sl-ligament injuries, while open reduction, ligament suture and/ or K-wire pinning is mandatory for complete ligament tears according to Geissler grade IV. This manuscript describes the current literature and gives insight into the authors' opinions and practice.