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Review
. 2019 Sep;12(3):379-385.
doi: 10.1007/s12178-019-09555-5. Epub 2019 Jul 13.

Management of High Energy Distal Radius Injuries

Janice J He  1 , Philip Blazar  2
Affiliations
Review

Management of High Energy Distal Radius Injuries

Janice J He et al. Curr Rev Musculoskelet Med. 2019 Sep.

Abstract

Purpose of review: High energy distal radius are commonly multi-fragmentary with significant comminution and/or bone loss. They can also be associated with ligamentous and soft tissue injury and neurovascular compromise. As such, reconstruction of these injuries can be challenging. This paper will review the relevant anatomy, different methods of fixation, and present techniques for difficult fractures.

Recent findings: Volar locked plating is a successful, very common method of treatment for distal radius fractures, but dorsal plating, fragment specific fixation, spanning bridge plating, and external fixation are sometimes necessary, particularly in higher energy injuries characterized by metaphyseal comminution, small volar fragments, intra-articular free fragments or lunate facet subsidence. Extended flexor carpi radialis (FCR), dorsal, and flexor carpi ulnaris (FCU) exposures can assist in visualizing the fracture site. There are many different modes of fixation for distal radius fractures, and successful outcome depends on selection of appropriate fixation based on the fracture pattern and status of the soft tissues.

Keywords: Articular fracture; Comminuted fracture; Distal radius; Hand trauma; Open reduction internal fixation.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
This illustrates the column model of the wrist, which consists of the radial, intermediate, and ulnar columns
Fig. 2
Fig. 2
The commonly seen articular fragments in intra-articular distal radius fractures
Fig. 3
Fig. 3
The intervals labeled 1–4 show the possible intervals between extensor compartments which could be utilized to visualize the fracture and to instrument
Fig. 4
Fig. 4
a The use of fragment specific fixation in setting of very distal fracture with intra-articular split (case courtesy of Chaitanya Mudgal). b The use of external fixation to augment volar locked plating in the setting of highly comminuted distal radial fracture with long metaphyseal fracture (case courtesy of Nishant Suneja). c Fragment specific fixation of the “critical corner,” or volar ulnar rim using tension band construct
See this image and copyright information in PMC

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