only includes various modalities of management

1. MANAGEMENT OF DISTAL
RADIUS FRACTURES
Dr. HARSHA NANDINI TALASILA
M.S Ortho

2. CLOSED REDUCTION
• All fractures must undergo closed reduction,even if it is expected that
surgical management will be needed
Fracture reduction helps :
• To limit postinjury swelling
• Provides pain relief
• Relieves (if any) compression on the median nerve.

3. Indications for Closed Treatment
• Non displaced or minimally displaced fractures
• Displaced fractures with a stable fracture pattern which can be
expected to unit within acceptable radiological parameters
• Low demand elderly patients in whom future functional impairment
is less of a priority than immediate health concerns and or operative
risks

4. Technique of Closed Reduction
Anesthesia
• Hematoma block
• Intravenous sedation
• Bier block
Reduction Maneuver (dorsally tilted fracture):
• Distal fragment is hyperextended
• Traction is applied to reduce the distal to the proximal
fragment with pressure applied to the distal radius.
Apply well-molded splint or cast.
Check X-ray to confirm the acceptable reduction.

5. • Once the swelling is subsided,a well molded cast is applied.
• The splint should leave the Metacarpophalyngeal joints free.
• The cast should be worn for 6 weeks or until radiological evidence of
union has occurred.
• The patient should be adviced full range of finger motion during
immobilization to minimize finger stiffness

6. RADIOLOGICAL CRITERIA FOR ACCEPTABLE
REDUCTION OF DISTAL RADIUS FRACTURE
CRITERIA NORMAL ACCEPTABLE
Ulnar variance +/-2mm comparing level of lunate
facet to ulnar head
No more than 2mm of shortening
relative to ulnar head
Palmar tilt 11 degrees volar tilt Neutral
Radial inclination 20 degrees as measured from
lunate facet to radial styloid
No less than 10 degrees
Intraarticular step or gap None Less than 2mm

7. SURGICAL MANAGEMENT

8. Indications for Surgical Treatment
1. High-energy injury
2. Secondary Loss of reduction
3. Comminuted displaced intraarticular fracture,step off
4. Metaphyseal comminution or bone loss
5. Open injury
6. Assosciated carpal fractures
7. Assosciated neurovascular or tendon injuries
8. Bilateral distal radius fractures
9. An impaired contralateral extremity
10. DRUJ incongruity

9. PERCUTANEOUS PINNING
• Anatomic reduction is obtained first
and then stability is provided by K
wires
• Pins: radial styloid across to the medial
radial metaphysis and diaphysis.
• Atleast 2 pins are applied.
• Confirm reduction on AP and lateral
views.

10. OPEN REDUCTION INTERNAL
FIXATION

11. Internal Fixation of Distal Radius
Fractures
• elevation of depressed articular fragments
• required if articular fragments can not be adequately
reduced with percutaneous methods

12. Selection of Approach
Volar approach is most commonly used
Dorsal approach
• Dorsal die punch fractures
• Displaced dorsal lunate facet fragments

13. VOLAR

14. Volar –Henry Approach

15. MODIFIED HENRY’S APPROACH

18. External fixation
• Method of choice for fractures with intra-articular
components and extensive metaphyseal comminution.
• TYPES:
1. NON SPANNING
2. SPANNING
3. AUGMENTED EXTERNAL FIXATION

19. Pin Placement

22. • NON SPANNING EXTERNAL FIXATION:
minimally comminuted extraarticular.
Simple articular fractures with good bone stock

24. DISTRACTION PLATE FIXATION
• Alternative to external fixation
• The plate is applied to the dorsal
surface of the hand,wrist and distal
forarm using 3 small incisions.
• External fixation pin site problems are
avoided.
• The plate is in place as long as
necessary for union.

26. AUGMENTED EXTERNAL FIXATION
• External fixation Along with Cross K
wire Fixation.
• One k wire through the radial styloid
• One through the dorsal ulnar
fragment into the radial shaft

27. FRAGMENT SPECIFIC OPEN REDUCTION INTERNAL
FIXATION OF COMMINUTED DISTAL RADIUS
FRACTURES
• 5 potential fracture fragments:
1. Radial column
2. Dorsal cortical wall
3. Dorsal ulnar split
4. Volar rim
5. Central intraarticular fragment

31. COMPLICATIONS OF DISTAL RADIUS
FRACTURES
• Malunion
Results from inadequate fracture reduction or stabilization
Treated with osteotomy and internal fixation and bone grafting
• Finger,wrist and elbow stiffness
• Median nerve dysfunction
• Tendon rupture: extensor policis longus tendon
• Posttraumatic osteoarthritis
• Midcarpal instability

32. THANK YOU