Distal radius Fracture Discussion

Distal radius fractures account for about one out of every six of fractures seen in the emergency room and three out of four forearm fractures. They are most common in both sexes between 6 and 10 years and in women between 60 and 69 years old. They may be classified by a number of schemes, the simplest being nondisplaced, displaced extraarticular and displaced intraarticular. A large number of operative and nonoperative treatment options have been recommended, many of which appear to give comparable results. Operative treatments include external fixation, percutaneous pinning, open reduction, and any combination of these. Poor final outcome is more likely when the fracture is initially very displaced, when the distal radioulnar joint is involved, and when the radiocarpal joint is comminuted. The importance of setting the fracture and accurately realigning the fragments is controversial. There are conflicting reports regarding the importance of final fracture alignment on function, although it is agreed that it is the primary reason for residual deformity following fracture. Reflex sympathetic dystrophy and finger stiffness occur to some degree in as many as one out of three patients. Loss of motion is also common, but unpredictable. Median or ulnar nerve compression may develop early or late following this fracture. Tendon rupture may follow this injury. Posttraumatic arthritis may develop, and is most common in young adults, seen in radiographs of two out of three young patients evaluated years after injury. Fortunately, radiographs do not correlate well with the degree of symptoms, and many of these patients are asymptomatic. Carpal instability may develop, either as a discrete ligament injury or as a result of changes in the radiocarpal joint angle. Nonunion of associated ulnar styloid fractures is common and usually painless. Prolonged (six to twelve months) recovery is typical, as are long term subjective symptoms, such as pain, fatigability, and loss of grip strength. Such symptoms can be expected to in about half of patients with a non-compensation related injury; in about four out of five adult patients under the age of 45, and in essentially all patients with compensation-related injury. Despite this, three out of four patients on the average have a satisfactory functional result following distal radius fracture.

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