Current Trends in Management of Comminuted Distal Radius Fractures in Adults

Abstract

Fractures of the distal radius represents the most common fracture of the upper extremity and probably the most common fracture of the human skeleton in general. It has been estimated to account for one sixth of all fractures that are seen and treated in emergency room. (110) Distal radial fractures frequently occur into two age groups; those of 6-10years old and those between 60-69 years old. These fractures occur usually in old osteoporotic women more than men and due to low-energy falls. It is unusually associated with radiocarpal and distal radioulnar joints injury. Despite the frequency of distal radius fractures, the optimal treatment remains without consensus opinion. A trend toward increased distal radius fracture open reduction and internal fixation has been identified, with biomechanical and clinical studies suggesting treatment advantages of certain fixation methods over others. There is not a single method that performs well in the treatment of all kinds of distal radius fractures. Also, no osteosynthesis method gives clearly better results than another in the treatment of the most common type of fractures. The following are different types of surgical management of the distal radius fracture: 1- Closed reduction with percutaneous pinning 2- External fixation: a- Bridging external fixation b- Non-bridging external fixation 3- Internal fixation: a- specific fragment fixation b- Dorsal plates c- Volar fixed-angle plates Surgeons treating fractures of distal radius should build an armamentarium of different methods that they are familiar enough with. Every new method needs to be properly learned before starting to use it. All surgeons do not need to treat all the most difficult fractures and instability related to distal radius fractures. A referral to a unit that is better prepared to treat more difficult fractures usually means more efficient treatment with less reoperations and less complications.