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Distal
radius fractures
This type of wrist fracture accounts for about one out of every six of fractures seen in the accident ward, and three out of four forearm fractures. Distal radius fractures are difficult to classify, as evidenced by the fact that there are over 20 different published classification systems for distal radius fractures, based on mechanism of injury, on fracture geometry, and on relative treatment indications. The simplest classification describes these fractures as being nondisplaced, displaced extraarticular and displaced intraarticular. The most simple subclassification of intraarticular distal radius fractures identifies the number of fracture fragments: two-part, three-part, four-part and comminuted (Fig. 11). Many operative and nonoperative treatment options exist, many of which appear to give comparable results. Optimum treatment is controversial because alignment documented on late radi ographs does not correlate well with the extent of late symptoms. Recent publications reflect an increasing awareness of the unpredictability of repeated closed reductions and a trend toward a more aggressive primary operative approach for these fractures. Operative treatment options include external fixation, percutaneous pinning, open reduction, and any combination of these (Fig. 12). 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. Progressive loss of reduction is more common in the elderly patient who depends more on upper extremity weight bearing. Reflex sympathetic dystrophy, finger stiffness and ulnar styloid nonunion are common complications. Carpal tunnel syndrome, posttraumatic arthritis, tendon rupture and carpal instability are also associated complications. Prolonged (six to twelve months) symptomatic reco very is typical, as are long-term subjective symptoms, such as pain, fatigability, and loss of grip strength. Despite this, at least three out of four patients on the average have a satisfactory functional result following distal radius fracture.
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