Top

Archives of Orthopaedic and Trauma Surgery

Published in:

01-05-2020 | Distal Radius Fracture | Handsurgery

Indications, surgical approach, reduction, and stabilization techniques of distal radius fractures

Authors: M. Leixnering, R. Rosenauer, Ch. Pezzei, J. Jurkowitsch, T. Beer, T. Keuchel, D. Simon, T. Hausner, S. Quadlbauer

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 5/2020

Abstract

Distal Radius fractures (DRF) are one of the most common injuries in the upper extremity and incidence is expected to rise due to a growing elderly population. The complex decision to treat patients operatively or conservatively depends on a large variety of parameters which have to be considered. No unanimous consensus has been reached yet, which operative approach and fixation technique would produce the best postoperative functional results with lowest complication rates. This article addresses the available evidence for indications, approaches, reduction, and fixation techniques in treating DRF.

MacIntyre NJ, Dewan N (2016) Epidemiology of distal radius fractures and factors predicting risk and prognosis. J Hand Ther 29:136–145. https://doi.org/10.1016/j.jht.2016.03.003 CrossRefPubMed

Schermann H, Kadar A, Dolkart O et al (2018) Repeated closed reduction attempts of distal radius fractures in the emergency department. Arch Orthop Trauma Surg 138:591–596. https://doi.org/10.1007/s00402-018-2904-2 CrossRefPubMed

Weil NL, El Moumni M, Rubinstein SM et al (2017) Routine follow-up radiographs for distal radius fractures are seldom clinically substantiated. Arch Orthop Trauma Surg 137:1187–1191. https://doi.org/10.1007/s00402-017-2743-6 CrossRefPubMedPubMedCentral

Quadlbauer S, Pezzei C, Hintringer W et al (2018) Clinical examination of the distal radioulnar joint. Orthopade 47:628–636CrossRef

Hohendorff B, Knappwerth C, Franke J et al (2018) Pronator quadratus repair with a part of the brachioradialis muscle insertion in volar plate fixation of distal radius fractures: a prospective randomised trial. Arch Orthop Trauma Surg 138:1479–1485. https://doi.org/10.1007/s00402-018-2999-5 CrossRefPubMed

Rotman D, Schermann H, Kadar A (2019) Displaced distal radius fracture presenting with neuropraxia of the dorsal cutaneous branch of the ulnar nerve (DCBUN). Arch Orthop Trauma Surg 139:1021–1023. https://doi.org/10.1007/s00402-019-03191-x CrossRefPubMed

Suda AJ, Schamberger CT, Viergutz T (2019) Donor site complications following anterior iliac crest bone graft for treatment of distal radius fractures. Arch Orthop Trauma Surg 139:423–428. https://doi.org/10.1007/s00402-018-3098-3 CrossRefPubMed

Schlickum L, Quadlbauer S, Pezzei C et al (2018) Three-dimensional kinematics of the flexor pollicis longus tendon in relation to the position of the FPL plate and distal radius width. Arch Orthop Trauma Surg. https://doi.org/10.1007/s00402-018-3081-z CrossRefPubMed

Gabl M, Arora R, Klauser AS, Schmidle G (2016) Characteristics of secondary arthrofibrosis after intra-articular distal radius fracture. Arch Orthop Trauma Surg 136:1181–1188. https://doi.org/10.1007/s00402-016-2490-0 CrossRefPubMed

10.

Quadlbauer S, Pezzei C, Jurkowitsch J et al (2020) Rehabilitation after distal radius fractures: is there a need for immobilization and physiotherapy? Arch Orthop Trauma Surg. https://doi.org/10.1007/s00402-020-03367-w CrossRefPubMed

11.

Figl M, Weninger P, Liska M et al (2009) Volar fixed-angle plate osteosynthesis of unstable distal radius fractures: 12 months results. Arch Orthop Trauma Surg 129:661–669. https://doi.org/10.1007/s00402-009-0830-z CrossRefPubMed

12.

Esenwein P, Sonderegger J, Gruenert J et al (2013) Complications following palmar plate fixation of distal radius fractures: a review of 665 cases. Arch Orthop Trauma Surg 133:1155–1162CrossRef

13.

Quadlbauer S, Pezzei C, Jurkowitsch J et al (2018) Early complications and radiological outcome after distal radius fractures stabilized by volar angular stable locking plate. Arch Orthop Trauma Surg 138:1773–1782. https://doi.org/10.1007/s00402-018-3051-5 CrossRefPubMed

14.

Weschenfelder W, Friedel R, Hofmann GO, Lenz M (2019) Acute atraumatic carpal tunnel syndrome due to flexor tendon rupture following palmar plate osteosynthesis in a patient taking rivaroxaban. Arch Orthop Trauma Surg 139:435–438. https://doi.org/10.1007/s00402-019-03116-8 CrossRefPubMed

15.

Gologan RE, Koeck M, Suda AJ, Obertacke U (2019) %3e 10-year outcome of dislocated radial fractures with concomitant intracarpal lesions as proven by MRI and CT. Arch Orthop Trauma Surg 139:877–881. https://doi.org/10.1007/s00402-019-03186-8 CrossRefPubMed

16.

Gologan R, Ginter VM, Haeffner A et al (2016) 1-Year outcome of concomitant intracarpal lesions in patients with dislocated distal radial fractures: a systematic assessment of 78 distal radial fractures. Arch Orthop Trauma Surg 136:425–432. https://doi.org/10.1007/s00402-015-2357-9 CrossRefPubMed

17.

Lameijer CM, ten Duis HJ, van Dusseldorp I et al (2017) Prevalence of posttraumatic arthritis and the association with outcome measures following distal radius fractures in non-osteoporotic patients: a systematic review. Arch Orthop Trauma Surg 137:1499–1513. https://doi.org/10.1007/s00402-017-2765-0 CrossRefPubMedPubMedCentral

18.

Lameijer CM, Ten Duis HJ, Vroling D et al (2018) Prevalence of posttraumatic arthritis following distal radius fractures in non-osteoporotic patients and the association with radiological measurements, clinician and patient-reported outcomes. Arch Orthop Trauma Surg 138:1699–1712. https://doi.org/10.1007/s00402-018-3046-2 CrossRefPubMedPubMedCentral

19.

Erhart S, Toth S, Kaiser P et al (2018) Comparison of volarly and dorsally displaced distal radius fracture treated by volar locking plate fixation. Arch Orthop Trauma Surg 138:879–885. https://doi.org/10.1007/s00402-018-2925-x CrossRefPubMed

20.

Quadlbauer S, Pezzei C, Jurkowitsch J et al (2016) Early rehabilitation of distal radius fractures stabilized by volar locking plate: a prospective randomized pilot study. J Wrist Surg 06:102–112. https://doi.org/10.1055/s-0036-1587317 CrossRef

21.

Quadlbauer S, Leixnering M, Jurkowitsch J et al (2017) Volar radioscapholunate arthrodesis and distal scaphoidectomy after malunited distal radius fractures. J Hand Surg Am 42:754.e1–754.e8. https://doi.org/10.1016/j.jhsa.2017.05.031 CrossRef

22.

Quadlbauer S, Pezzei C, Jurkowitsch J et al (2017) Spontaneous radioscapholunate fusion after septic arthritis of the wrist: a case report. Arch Orthop Trauma Surg 137:579–584. https://doi.org/10.1007/s00402-017-2659-1 CrossRefPubMed

23.

Krimmer H, Unglaub F, Langer MF, Spies CK (2016) The distal radial decompression osteotomy for ulnar impingement syndrome. Arch Orthop Trauma Surg 136:143–148. https://doi.org/10.1007/s00402-015-2363-y CrossRefPubMed

24.

Keuchel T, Quadlbauer S, Jurkowitsch J et al (2020) Salvage procedure after malunited distal radius fractures and management of pain and stiffness. Arch Orthop Trauma Surg. https://doi.org/10.1007/s00402-020-03369-8 CrossRefPubMed

25.

Vannabouathong C, Hussain N, Guerra-Farfan E, Bhandari M (2019) Interventions for distal radius fractures. J Am Acad Orthop Surg 27:e596–e605. https://doi.org/10.5435/JAAOS-D-18-00424 CrossRefPubMed

26.

Le ZS, Kan SL, Su LX, Wang B (2015) Meta-analysis for dorsally displaced distal radius fracture fixation: volar locking plate versus percutaneous Kirschner wires. J Orthop Surg Res. https://doi.org/10.1186/s13018-015-0252-2 CrossRef

27.

Wei DH, Raizman NM, Bottino CJ et al (2009) Unstable distal radial fractures treated with external fixation, a radial column plate, or a volar plate: a prospective randomized trial. J Bone Jt Surg 91:1568–1577. https://doi.org/10.2106/JBJS.H.00722 CrossRef

28.

Rubin G, Orbach H, Chezar A, Rozen N (2017) Treatment of physeal fractures of the distal radius by volar intrafocal Kapandji method: surgical technique. Arch Orthop Trauma Surg 137:49–54. https://doi.org/10.1007/s00402-016-2592-8 CrossRefPubMed

29.

Foldager-Jensen AD (2014) The clinical dilemma: nonoperative or operative treatment. In: Hove LM, Lindau T, Hølmer P (eds) Distal radius fractures. Springer-Verlag, Berlin, pp 109–114

30.

Arora R, Lutz M, Deml C et al (2011) A prospective randomized trial comparing nonoperative treatment with volar locking plate fixation for displaced and unstable distal radial fractures in patients sixty-five years of age and older. J Bone Jt Surg Am 93:2146–2153. https://doi.org/10.2106/JBJS.J.01597 CrossRef

31.

Mackenney PJ, McQueen MM, Elton R (2006) Prediction of instability in distal radial fractures. J Bone Jt Surg 88:1944. https://doi.org/10.2106/JBJS.D.02520 CrossRef

32.

Rosenauer R, Pezzei C, Quadlbauer S et al (2020) Complications after operatively treated distal radius fractures. Arch Orthop Trauma Surg. https://doi.org/10.1007/s00402-020-03372-z CrossRefPubMed

33.

Makhni EC, Ewald TJ, Kelly S, Day CS (2008) Effect of patient age on the radiographic outcomes of distal radius fractures subject to nonoperative treatment. J Hand Surg Am 33:1301–1308. https://doi.org/10.1016/j.jhsa.2008.04.031 CrossRefPubMed

34.

Lichtman DM, Bindra RR, Boyer MI et al (2010) Treatment of distal radius fractures. J Am Acad Orthop Surg 18:180–189CrossRef

35.

Lafontaine M, Hardy D, Delince P (1989) Stability assessment of distal radius fractures. Injury 20:208–210CrossRef

36.

Tahririan MA, Javdan M, Nouraei MH, Dehghani M (2013) Evaluation of instability factors in distal radius fractures. J Res Med Sci 18:892–896PubMedPubMedCentral

37.

Walenkamp MMJ, Aydin S, Mulders MAM et al (2016) Predictors of unstable distal radius fractures: a systematic review and meta-analysis. J Hand Surg 41:501–515. https://doi.org/10.1177/1753193415604795 CrossRef

38.

Protopsaltis TS, Ruch DS (2008) Volar approach to distal radius fractures. J Hand Surg Am 33:958–965. https://doi.org/10.1016/j.jhsa.2008.04.018 CrossRefPubMed

39.

Diaz-Garcia RJ, Oda T, Shauver MJ, Chung KC (2011) A systematic review of outcomes and complications of treating unstable distal radius fractures in the elderly. J Hand Surg Am 36:824–835. https://doi.org/10.1016/j.jhsa.2011.02.005 CrossRefPubMedPubMedCentral

40.

Egol KA, Walsh M, Romo-Cardoso S et al (2010) Distal radial fractures in the elderly: operative compared with nonoperative treatment. J Bone Jt Surg Am 92:1851–1857. https://doi.org/10.2106/JBJS.I.00968 CrossRef

41.

Chen Y, Chen X, Li Z et al (2016) Safety and efficacy of operative versus nonsurgical management of distal radius fractures in elderly patients: a systematic review and meta-analysis. J Hand Surg Am 41:404–413. https://doi.org/10.1016/j.jhsa.2015.12.008 CrossRefPubMed

42.

Song J, Yu A-X, Li Z-H (2015) Comparison of conservative and operative treatment for distal radius fracture: a meta-analysis of randomized controlled trials. Int J Clin Exp Med 8:17023–17035PubMedPubMedCentral

43.

Unglaub F, Langer MF, Hohendorff B et al (2017) Distale radiusfraktur. Orthopade 46:93–110. https://doi.org/10.1007/s00132-016-3347-5 CrossRefPubMed

44.

Bentohami A, De Burlet K, De Korte N et al (2014) Complications following volar locking plate fixation for distal radial fractures: a systematic review. J Hand Surg Eur 39:745–754. https://doi.org/10.1177/1753193413511936 CrossRef

45.

Fujitani R, Omokawa S, Iida A et al (2012) Reliability and clinical importance of teardrop angle measurement in intra-articular distal radius fracture. J Hand Surg Am 37:454–459. https://doi.org/10.1016/j.jhsa.2011.10.056 CrossRefPubMed

46.

Medoff RJ (2005) Essential radiographic evaluation for distal radius fractures. Hand Clin 21:279–288. https://doi.org/10.1016/j.hcl.2005.02.008 CrossRefPubMed

47.

Surke C, Raschke M, Langer M (2012) Distale radiusfraktur: versorgungsstrategien beim älteren menschen. OP J 28:256–260. https://doi.org/10.1055/s-0032-1327997 CrossRef

48.

Jeffrey Cole R, Bindra RR, Evanoff BA et al (1997) Radiographic evaluation of osseous displacement following intra-articular fractures of the distal radius: reliability of plain radiography versus computed tomography. J Hand Surg Am 22:792–800. https://doi.org/10.1016/S0363-5023(97)80071-8 CrossRef

49.

Knirk JL, Jupiter JB (1986) Intra-articular fractures of the distal end of the radius in young adults. J Bone Jt Surg Am 68:647–659CrossRef

50.

Harness NG, Ring D, Zurakowski D et al (2006) The influence of three-dimensional computed tomography reconstructions on the characterization and treatment of distal radial fractures. J Bone Jt Surg 88:1315–1323. https://doi.org/10.2106/JBJS.E.00686 CrossRef

51.

Schmutz B, Kmiec S, Wullschleger ME et al (2017) 3D Computer graphical anatomy study of the femur: a basis for a new nail design. Arch Orthop Trauma Surg 137:321–331. https://doi.org/10.1007/s00402-016-2621-7 CrossRefPubMed

52.

Hintringer W, Rosenauer R, Pezzei C et al (2020) Biomechanical considerations on a CT based treatment-oriented classification in radius fractures. Arch Orthop Trauma Surg. https://doi.org/10.1007/s00402-020-03405-7 CrossRefPubMed

53.

Handoll HHG, Elliott J (2015) Rehabilitation for distal radial fractures in adults. Cochrane Database Syst Rev 9:CD003324. https://doi.org/10.1002/14651858.CD003324.pub3 CrossRef

54.

Conti Mica MA, Bindra R, Moran SL (2017) Anatomic considerations when performing the modified Henry approach for exposure of distal radius fractures. J Orthop 14:104–107. https://doi.org/10.1016/j.jor.2016.10.015 CrossRefPubMed

55.

Ilyas AM (2011) Surgical approaches to the distal radius. Hand 6:8–17. https://doi.org/10.1007/s11552-010-9281-9 CrossRefPubMed

56.

Jupiter JB, Fernandez DL, Toh CL et al (1996) Operative treatment of volar intra-articular fractures of the distal end of the radius. J Bone Jt Surg 78:1817–1828. https://doi.org/10.2106/00004623-199612000-00004 CrossRef

57.

Orbay JL, Fernandez DL (2002) Volar fixation for dorsally displaced fractures of the distal radius: a preliminary report. J Hand Surg Am 27:205–215. https://doi.org/10.1053/jhsu.2002.32081 CrossRefPubMed

58.

Henry AK (1927) Complete exposure of the radius. Exposures of long bones and other surgical methods. John Wiley and Sons Ltd., New Jersey, pp 9–12

59.

Orbay J, Badia A, Khoury RK et al (2004) Volar fixed-angle fixation of distal radius fractures: the DVR plate. Tech Hand Up Extrem Surg 8:142–148. https://doi.org/10.1097/01.bth.0000126570.82826.0a CrossRefPubMed

60.

Chirpaz-Cerbat J-M, Ruatti S, Houillon C, Ionescu S (2011) Dorsally displaced distal radius fractures treated by fixed-angle volar plating: Grip and pronosupination strength recovery. A prospective study. Orthop Traumatol Surg Res 97:465–470. https://doi.org/10.1016/j.otsr.2011.01.016 CrossRefPubMed

61.

Mulders MAM, Walenkamp MMJ, Bos FJME et al (2017) Repair of the pronator quadratus after volar plate fixation in distal radius fractures: a systematic review. Strateg Trauma Limb Reconstr 12:1–8. https://doi.org/10.1007/s11751-017-0288-4 CrossRef

62.

Alluri RK, Hill JR, Ghiassi A (2016) Distal radius fractures: approaches, indications, and techniques. J Hand Surg Am 41:845–854CrossRef

63.

Mares O, Coulomb R, Lazerges C et al (2016) Surgical exposures for distal radius fractures. Hand Surg Rehabil 35:39–43CrossRef

64.

Spies CKG, Langer M, Müller L et al (2020) Distal radioulnar joint instability – current concepts of treatment. Arch Orthop Trauma Surg. https://doi.org/10.1007/s00402-020-03371-0 CrossRefPubMed

65.

Disseldorp DJG, Hannemann PFW, Poeze M, Brink PRG (2016) Dorsal or volar plate fixation of the distal radius: does the complication rate help us to choose? J Wrist Surg 05:202–210. https://doi.org/10.1055/s-0036-1571842 CrossRef

66.

Simic PM, Robison J, Gardner MJ et al (2006) Treatment of distal radius fractures with a low-profile dorsal plating system: an outcomes assessment. J Hand Surg Am. https://doi.org/10.1016/j.jhsa.2005.10.016 CrossRefPubMed

67.

Kamath AF, Zurakowski D, Day CS (2006) Low-profile dorsal plating for dorsally angulated distal radius fractures: an outcomes study. J Hand Surg Am. https://doi.org/10.1016/j.jhsa.2006.05.008 CrossRefPubMed

68.

Wei J, Yang TB, Luo W et al (2013) Complications following dorsal versus volar plate fixation of distal radius fracture: a meta-analysis. J Int Med Res. https://doi.org/10.1177/0300060513476438 CrossRefPubMed

69.

Kumar S, Khan AN, Sonanis SV (2016) Radiographic and functional evaluation of low profile dorsal versus volar plating for distal radius fractures. J Orthop. https://doi.org/10.1016/j.jor.2016.06.017 CrossRefPubMedPubMedCentral

70.

Abe Y, Tokunaga S, Moriya T (2017) Management of intra-articular distal radius fractures: volar or dorsal locking plate which has fewer complications? Hand. https://doi.org/10.1177/1558944716675129 CrossRefPubMed

71.

Kastenberger T, Kaiser P, Schwendinger P et al (2020) Arthroscopic assisted treatment of distal radius fractures and concomitant injuries. Arch Orthop Trauma. https://doi.org/10.1007/s00402-020-03373-y CrossRef

72.

Kapandji A (1976) Internal fixation by double intrafocal plate. Functional treatment of non articular fractures of the lower end of the radius. Ann Chir 30:903–908PubMed

73.

Orbay JL, Badia A, Indriago IR et al (2001) The extended flexor carpi radialis approach: a new perspective for the distal radius fracture. Tech Hand Up Extrem Surg. https://doi.org/10.1097/00130911-200112000-00004 CrossRefPubMed

74.

Kaiser P, Gruber H, Loth F et al (2019) Positioning of a volar locking plate with a central flexor pollicis longus tendon notch in distal radius fractures. J Wrist Surg. https://doi.org/10.1055/s-0039-1694718 CrossRefPubMed

75.

Spies CK, Müller LP, Oppermann J et al (2014) Die Instabilität des distalen Radioulnargelenks-Zur Wertigkeit klinischer und röntgenologischer Testverfahren-eine Literaturü bersicht. Handchir Mikrochir Plast Chir 46:137–150. https://doi.org/10.1055/s-0033-1363662 CrossRefPubMed

76.

Spies CK, Hahn P, Unglaub F et al (2015) Instability of the distal radioulnar joint: treatment options for ulnar lesions of the triangular fibrocartilage complex. Unfallchirurg. https://doi.org/10.1007/s00113-015-0044-5 CrossRefPubMed

77.

Kirchberger MC, Unglaub F, Mühldorfer-Fodor M et al (2015) Update TFCC: histology and pathology, classification, examination and diagnostics. Arch Orthop Trauma Surg 135:427–437. https://doi.org/10.1007/s00402-015-2153-6 CrossRefPubMed

Title: Indications, surgical approach, reduction, and stabilization techniques of distal radius fractures
Authors: M. Leixnering
R. Rosenauer
Ch. Pezzei
J. Jurkowitsch
T. Beer
T. Keuchel
D. Simon
T. Hausner
S. Quadlbauer
Publication date: 01-05-2020
Publisher: Springer Berlin Heidelberg
Keywords: Distal Radius Fracture
Extensor Tendon
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 5/2020
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-020-03365-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Indications, surgical approach, reduction, and stabilization techniques of distal radius fractures

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 5/2020

Distal radioulnar joint instability: current concepts of treatment

Ulnar shortening osteotomy as a treatment of symptomatic ulnar impaction syndrome after malunited distal radius fractures

Biomechanical considerations on a CT-based treatment-oriented classification in radius fractures

Corrective osteotomy after malunited distal radius fractures

Rehabilitation after distal radius fractures: is there a need for immobilization and physiotherapy?

Arthroscopic assisted treatment of distal radius fractures and concomitant injuries