distal radius

1. REZA DEVIANTO HAMBALI, DR.
PEMBIMBING:
DR.DR. M. RIZAL CHAIDIR., SPOT(K)., M.KES (MMR)., M.H. KES
DR.DR. NUCKI NURSJAMSI HIDAJAT SP.OT(K), M.KES
DR. WIDYAARSA SP.OT(K),CCD
DR. REALITA MALIK SP.OT

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4. Cylindrical long bone
• Head is intraarticular
• Tuberosity: biceps inserts
• Shaft has a bow
• Distal end widens, is made of
cancellous bone, has scaphoid
& lunate facets, & radial
styloid
• Ulnar (sigmoid) notch: DRUJ

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6. • I: extra-articular
II: like type 1 + distal ulnar
fracture;
III: involve radiocarpal joint;
IV: like type 3 with distal ulnar
fracture;
V: radioulnar distal joint
involvement
VI: type V5 with distal ulnar
fracture;
VII: distal radiocarpal and
radioulnar joint involvement;
VIII: type 7 + distal ulnar fracture

7. Swiss Association for the Study of Internal
Fixation (AO/ASIF)
I: undisplaced, no/minimal comminution;
II: 'die punch' fraktur with translation(IIa: reducible; IIb:
irreducible);
III fragmen spike;
IV: separation of intra-articular fragment;
V: burst fracture
23-A extra-articular;
23-B partial articular;
23-C complete articular

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I: intra-articular, undisplaced;
II: intra-articular, displaced,
most of articular surface;
III: intra-articular, displaced,
fraktur 'die punch' fossa
lunatum;
IV: intra-artikular, displaced,
involve both radioskafoid
surface and fossa sigmoid distal
radioulnar joint, comminutive

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I: Metaphysis bending ;
II: fraktur movement on articular
surface;
III: compression on articular
surface;
IV: avulsi atau radiocarpal fracture
dislocation;
V: compound fracture associated
with high energy injury

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Salter-Harris CLassification

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18. Nonoperative indications:
■ Nondisplaced or minimally displaced fractures
■ Displaced fractures with a stable fracture pattern
which can be expected to unite within
acceptable radiographic parameters
■ Low-demand elderly patients in whom future
functional impairment is less of a priority than
immediate health concerns and/or operative risks
Technique of closed reduction (dorsally tilted
fracture):
■ The distal fragment is hyperextended.
■ Traction is applied to reduce the distal to the proximal
fragment with pressure applied to the
distal radius.
■ A well-molded long arm (“sugar-tong”) splint is
applied, with the wrist in neutral to slight
flexion.
■ One must avoid extreme positions of the wrist and
hand.
■ The splint should leave the metacarpophalangeal

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20. Volar approach
■ Most commonly used approach with advent of locked
plates
■ Interval is through floor of flexor carpi radialis tendon with
elevation of pronator quadratus
muscle
■ Transverse carpal ligament can be release through a
separate incision if median nerve
compression exists
Dorsal approach
■ Used to reduce and stabilize dorsal fragments
■ Interval is through 3rd dorsal compartment
■ May view articular surface via arthrotomy
Radial approach
■ Used to reduce and stabilize radial styloid fragments
■ Interval is between the 1st and 2nd dorsal compartments
Operative indications:
■ High-energy injury
■ Secondary loss of reduction
■ Articular comminution, step-off, or gap
■ Metaphyseal comminution or bone loss
■ Loss of volar buttress with displacement
■ DRUJ incongruity
■ Open fractures
■ Associated carpal fractures
■ Associated neurovascular or tendon injury
■ Bilateral distal radius fractures
■ An impaired contralateral extremity
External Fixation
•Indications:
•open fractures
•highly comminuted fractures
•medically unstable patients unable to undergo a lengthy
procedure

22. Percutaneous pinning:
This is primarily used for extra-articular fractures or two-part intraarticular
fractures.
■ It may be accomplished using two or three Kirschner wires placed across the fracture site,
generally from the radial styloid, directed proximally and from the dorsoulnar side of the distal
radial fragment directed proximally. Transulnar pinning with multiple pins has also been
described.
■ Percutaneous pinning is generally used to supplement short arm casting or external fixation. The
pins may be removed 6 to 8 weeks postoperatively, with the cast maintained for an additional 2
to 3 weeks.
Kapandji “intrafocal” pinning
■ This is a technique of trapping the distal fragment by buttressing to prevent displacement.
■ The wires are inserted both radially and dorsally directly into the fracture site. The wires are
then levered up and then directed into the proximal intact opposite cortex.
■ The fragments are thus buttressed from displacing dorsally or proximally.
■ In addition to being relatively simple and inexpensive, this technique has been shown to be very
effective, particularly in elderly patients.

23. Dorsal plating:
■ The approach avoids the neurovascular structures on the palmar side.
■ The fixation is on the compression side of the fracture and provides a buttress
against
collapse.
■ Initial reports of the technique demonstrated successful outcomes with the
theoretic
advantages of earlier return of function and better restoration of radial anatomy
than seen with
external fixation.
■ Dorsal plating has been associated with extensor tendon complications.
Volar nonlocked plating
■ This has fallen out of favor since the advent of locked volar plates, since the
implant may be
unable to maintain fracture reduction in the presence of dorsal comminution.
■ The dorsal side of the radius may be accessed through an extension of the volar
approach.
■ This allows for early range of wrist motion.
Fragment-specific plating
■ This has been advocated for more complex fracture patterns involving several
aspects of the
radial and ulnar columns.
■ The operative approach should be dictated by pre- and post-reduction

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