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Fractures of the Distal Radius

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Assessment of fractures and soft tissues

Fractures of the distal radius range from simple fractures to multi-fragmented fracture-dislocations of severe complexity which requires management of fractures accordingly. 

Closed reduction and cast or splint immobilization can be used to manage minimally displaced intra-articular, extra-articular fractures, and impacted stable fractures with minimal shortening. Usually, distal radius fractures involve the radiocarpal joint and/ or the distal radioulnar joint. They can be either partial articular i.e. type B fracture or complete articular i.e. type C fracture. These fractures need the anatomical reduction of the joint surface to reduce the possibility of post-traumatic arthrosis and to ensure the functional outcome. Therefore, operative treatment is needed for intra-articular fractures since they cannot be reduced with closed methods.

The age, activity level, hand dominance, occupation, and general medical condition of the patient with acute distal radius fracture must be evaluated. After that one must determine whether the fracture is open or closed, intra-articular or extra-articular neurovascular compromise is present or not, and the degree of displacement of the fragments. It is imperative to assess the mechanism of injury and quality of bone. The associated ligamentous lesions, subluxations, or fractures of the neighboring carpal bones, and the concomitant soft-tissue damage, are related to the degree and quality of trauma undergone. Moreover, the reduction of maneuvers will be dictated by the mechanism of injury. So it must be designed to reverse the injury-causing force.

Generally, for analyzing extra-articular fractures, AP and lateral x-rays of the wrist is needed. The assessment of hand fracture system shortening, the direction of displacement, and the amount of metaphyseal comminution needs to be done. In addition to it, oblique films especially 45 pronated and supinated, provides a clear view of the scaphoid and lunate facets as well and permits better evaluation of intra-articular fractures. After initial reduction, traction views or fluoroscopy with finger trap traction allows a better assessment of intra-articular comminution. Intra-articular displacement can be viewed in tri-spiral tomograms and are also useful for complex intra-articular fractures.

Lunate facet injuries including the association of the distal radioulnar joint, as well as associated distal radioulnar joint subluxation, can be viewed better in Computed tomography.  Magnetic resonance imaging (MRI) is required for the evaluation of associated intercarpal ligament injuries and triangular fibrocartilage tears at later stages. Though it is not required frequently.


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