Advertisement

Emergency Radiology

, Volume 23, Issue 2, pp 175–185 | Cite as

A biomechanical approach to distal radius fractures for the emergency radiologist

  • Paul M. Bunch
  • Scott E. Sheehan
  • George S. Dyer
  • Aaron Sodickson
  • Bharti Khurana
Review Article

Abstract

Distal radius fractures are the most common upper extremity fracture and account for approximately one sixth of all fractures treated in US emergency departments. These fractures are associated with significant morbidity and have a major economic impact. Radiographic evaluation of distal radius fractures is frequently performed in the emergency department setting, has a profound impact on initial management, and is essential to assessing the quality and relative success of the initial reduction. While the most appropriate definitive management of distal radius fractures remains controversial, overarching treatment principles reflect distal radius injury mechanisms and biomechanics. An intuitive understanding of the biomechanics of the distal radius and of common mechanisms of injury informs and improves the emergency radiologist’s ability to identify key imaging findings with important management implications and to communicate the critical information that emergency physicians and orthopedic surgeons need to best manage distal radius fractures.

Keywords

Radius Fracture Trauma Wrist Biomechanical Mechanism 

Notes

Compliance with ethical standards

Conflict of interest

The work represented in this manuscript received no funding from any organization or institution.

One of the authors of this manuscript (G.S.D) is the program director of the Harvard Combined Orthopaedic Residency Program. The residency program receives educational support from Synthes and Stryker.

The other authors of this manuscript declare that they have no relevant financial conflicts of interest to disclose.

Supplementary material

10140_2015_1363_Fig8_ESM.gif (16 kb)
Online Resource 1

Three-column concept. PA radiograph of the wrist with color overlay (a) and computer-generated en face 3D view of the articular surface of the distal radius and ulna (b) demonstrate the three-column concept of the distal forearm. The radial column (blue) includes the radial styloid and scaphoid fossa, the intermediate column (yellow) includes the lunate fossa and sigmoid notch, and the ulnar column (red) includes the distal ulna, the distal radioulnar joint (DRUJ), and the triangular fibrocartilage complex (TFCC) (GIF 16 kb)

10140_2015_1363_Fig9_ESM.gif (9 kb)
Online Resource 1

Three-column concept. PA radiograph of the wrist with color overlay (a) and computer-generated en face 3D view of the articular surface of the distal radius and ulna (b) demonstrate the three-column concept of the distal forearm. The radial column (blue) includes the radial styloid and scaphoid fossa, the intermediate column (yellow) includes the lunate fossa and sigmoid notch, and the ulnar column (red) includes the distal ulna, the distal radioulnar joint (DRUJ), and the triangular fibrocartilage complex (TFCC) (GIF 16 kb)

10140_2015_1363_MOESM1_ESM.tif (1.2 mb)
High Resolution Image (TIF 1,270 kb)
10140_2015_1363_MOESM2_ESM.tif (677 kb)
High Resolution Image (TIF 677 kb)
10140_2015_1363_Fig10_ESM.gif (10 kb)
Online Resource 2

Computed tomography evaluation. (a) Axial CT image of the splinted wrist through the level of Lister’s tubercle (asterisk) demonstrates a longitudinal fracture of the distal radius extending to involve the DRUJ at the sigmoid notch (white arrow). The DRUJ extension was radiographically occult. (b) Coronal CT image of the wrist in a different patient demonstrates an impacted bending distal radius fracture through the distal radius fracture zone (arrows). (c) Coronal CT image of the wrist in a different patient demonstrates an impacted distal radius compression fracture. Note the slight depression of the lunate fossa and resultant articular incongruity (arrow) (GIF 10 kb)

10140_2015_1363_Fig11_ESM.gif (74 kb)
Online Resource 2

Computed tomography evaluation. (a) Axial CT image of the splinted wrist through the level of Lister’s tubercle (asterisk) demonstrates a longitudinal fracture of the distal radius extending to involve the DRUJ at the sigmoid notch (white arrow). The DRUJ extension was radiographically occult. (b) Coronal CT image of the wrist in a different patient demonstrates an impacted bending distal radius fracture through the distal radius fracture zone (arrows). (c) Coronal CT image of the wrist in a different patient demonstrates an impacted distal radius compression fracture. Note the slight depression of the lunate fossa and resultant articular incongruity (arrow) (GIF 10 kb)

10140_2015_1363_Fig12_ESM.gif (25 kb)
Online Resource 2

Computed tomography evaluation. (a) Axial CT image of the splinted wrist through the level of Lister’s tubercle (asterisk) demonstrates a longitudinal fracture of the distal radius extending to involve the DRUJ at the sigmoid notch (white arrow). The DRUJ extension was radiographically occult. (b) Coronal CT image of the wrist in a different patient demonstrates an impacted bending distal radius fracture through the distal radius fracture zone (arrows). (c) Coronal CT image of the wrist in a different patient demonstrates an impacted distal radius compression fracture. Note the slight depression of the lunate fossa and resultant articular incongruity (arrow) (GIF 10 kb)

10140_2015_1363_MOESM3_ESM.tif (798 kb)
High Resolution Image (TIF 798 kb)
10140_2015_1363_MOESM4_ESM.tif (5 mb)
High Resolution Image (TIF 5,113 kb)
10140_2015_1363_MOESM5_ESM.tif (1.6 mb)
High Resolution Image (TIF 1,688 kb)
10140_2015_1363_Fig13_ESM.gif (38 kb)
Online Resource 7

Radiographic features favoring instability in four different patients. (a) PA radiograph of the wrist demonstrates a bending distal radius fracture through the distal radius fracture zone with approximately one quarter shaft width initial displacement (arrows). Note the associated radial shortening/positive ulnar variance (asterisk). (b) PA radiograph of the wrist demonstrates a severely comminuted (arrows) distal radius compression fracture with associated positive ulnar variance (asterisk). (c) PA radiograph of the wrist demonstrates a distal radius compression fracture with associated distal ulnar fracture, both occurring in the setting of severe osteoporosis. Note the articular incongruity of the distal radial articular surface (arrow). (d) Lateral radiograph of the wrist demonstrates a bending fracture of the distal radius with marked initial dorsal angulation (arrows) (GIF 38 kb)

10140_2015_1363_Fig14_ESM.gif (22 kb)
Online Resource 7

Radiographic features favoring instability in four different patients. (a) PA radiograph of the wrist demonstrates a bending distal radius fracture through the distal radius fracture zone with approximately one quarter shaft width initial displacement (arrows). Note the associated radial shortening/positive ulnar variance (asterisk). (b) PA radiograph of the wrist demonstrates a severely comminuted (arrows) distal radius compression fracture with associated positive ulnar variance (asterisk). (c) PA radiograph of the wrist demonstrates a distal radius compression fracture with associated distal ulnar fracture, both occurring in the setting of severe osteoporosis. Note the articular incongruity of the distal radial articular surface (arrow). (d) Lateral radiograph of the wrist demonstrates a bending fracture of the distal radius with marked initial dorsal angulation (arrows) (GIF 38 kb)

10140_2015_1363_Fig15_ESM.gif (29 kb)
Online Resource 7

Radiographic features favoring instability in four different patients. (a) PA radiograph of the wrist demonstrates a bending distal radius fracture through the distal radius fracture zone with approximately one quarter shaft width initial displacement (arrows). Note the associated radial shortening/positive ulnar variance (asterisk). (b) PA radiograph of the wrist demonstrates a severely comminuted (arrows) distal radius compression fracture with associated positive ulnar variance (asterisk). (c) PA radiograph of the wrist demonstrates a distal radius compression fracture with associated distal ulnar fracture, both occurring in the setting of severe osteoporosis. Note the articular incongruity of the distal radial articular surface (arrow). (d) Lateral radiograph of the wrist demonstrates a bending fracture of the distal radius with marked initial dorsal angulation (arrows) (GIF 38 kb)

10140_2015_1363_Fig16_ESM.gif (17 kb)
Online Resource 7

Radiographic features favoring instability in four different patients. (a) PA radiograph of the wrist demonstrates a bending distal radius fracture through the distal radius fracture zone with approximately one quarter shaft width initial displacement (arrows). Note the associated radial shortening/positive ulnar variance (asterisk). (b) PA radiograph of the wrist demonstrates a severely comminuted (arrows) distal radius compression fracture with associated positive ulnar variance (asterisk). (c) PA radiograph of the wrist demonstrates a distal radius compression fracture with associated distal ulnar fracture, both occurring in the setting of severe osteoporosis. Note the articular incongruity of the distal radial articular surface (arrow). (d) Lateral radiograph of the wrist demonstrates a bending fracture of the distal radius with marked initial dorsal angulation (arrows) (GIF 38 kb)

10140_2015_1363_MOESM6_ESM.tif (3.8 mb)
High Resolution Image (TIF 3,933 kb)
10140_2015_1363_MOESM7_ESM.tif (2.6 mb)
High Resolution Image (TIF 2,651 kb)
10140_2015_1363_MOESM8_ESM.tif (3.2 mb)
High Resolution Image (TIF 3,316 kb)
10140_2015_1363_MOESM9_ESM.tif (2.1 mb)
High Resolution Image (TIF 2,175 kb)
10140_2015_1363_MOESM10_ESM.mp4 (779 kb)
Online Resource 3 Computer-generated model of the distal radius demonstrates the dorsal bending type fracture mechanism, which results from a relatively low energy fall onto an extended, pronated wrist with a moderate angle of incidence leading to tensile failure of the volar cortex and compressive failure of the dorsal cortex (MP4 778 kb)
10140_2015_1363_MOESM11_ESM.mp4 (594 kb)
Online Resource 4 Computer-generated model of the distal radius demonstrates the dorsal shearing type fracture mechanism, which results from a relatively higher energy fall onto an extended, pronated wrist with a relatively low angle of incidence and onto a surface with a high coefficient of friction. On impact, forward motion of the hand stops, while forward motion of the distal radius continues, leading to shearing of a portion of the distal radial articular surface by the carpus (MP4 594 kb)
10140_2015_1363_MOESM12_ESM.mp4 (587 kb)
Online Resource 5 Computer-generated model of the distal radius demonstrates a variant mechanism for the compression type fracture, which in this instance results from a high-energy fall onto an extended, pronated wrist with a steep angle of incidence and a closed grip. As a result of axial loading, the carpus is driven into the articular surface of the distal radius, analogous to a hammer striking an anvil (MP4 587 kb)
10140_2015_1363_MOESM13_ESM.mp4 (3.2 mb)
Online Resource 6 Computer-generated model of the distal radius demonstrates the avulsion type fracture mechanism, which results from high-energy sudden traction and/or twisting forces acting on the wrist, as would be produced by heavy machinery. The traction and twisting forces act on the strong radiocarpal and ulnocarpal ligaments and lead to avulsion of the relatively weak styloid processes of the distal radius and ulna (MP4 3,294 kb)

References

  1. 1.
    Ilyas AM, Jupiter JB (2007) Distal radius fractures—classification of treatment and indications for surgery. Orthop Clin North Am 38:167–173. doi: 10.1016/j.ocl.2007.01.002 CrossRefPubMedGoogle Scholar
  2. 2.
    Nellans KW, Kowalski E, Chung KC (2012) The epidemiology of distal radius fractures. Hand Clin 28:113–125. doi: 10.1016/j.hcl.2012.02.001 CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Baron JA, Karagas M, Barrett J et al (1996) Basic epidemiology of fractures of the upper and lower limb among Americans over 65 years of age. Epidemiol Camb Mass 7:612–618CrossRefGoogle Scholar
  4. 4.
    Cooney WP, Dobyns JH, Linscheid RL (1980) Complications of Colles’ fractures. J Bone Joint Surg Am 62:613–619PubMedGoogle Scholar
  5. 5.
    Ryan LM, Teach SJ, Searcy K et al (2010) Epidemiology of pediatric forearm fractures in Washington, DC. J Trauma 69:S200–205. doi: 10.1097/TA.0b013e3181f1e837 CrossRefPubMedGoogle Scholar
  6. 6.
    Shauver MJ, Yin H, Banerjee M, Chung KC (2011) Current and future national costs to medicare for the treatment of distal radius fracture in the elderly. J Hand Surg 36:1282–1287. doi: 10.1016/j.jhsa.2011.05.017 CrossRefGoogle Scholar
  7. 7.
    Medoff RJ (2009) Radiographic evaluation and classification of distal radius fractures. In: Slutsky D, Osterman A (eds) Fractures and injuries of the distal radius and carpus: the cutting edge, 1st edn. Saunders, Philadelphia, pp 17–31CrossRefGoogle Scholar
  8. 8.
    Medoff RJ (2005) Essential radiographic evaluation for distal radius fractures. Hand Clin 21:279–288. doi: 10.1016/j.hcl.2005.02.008 CrossRefPubMedGoogle Scholar
  9. 9.
    Members of the Writing, Review, and Voting Panels of the AUC on the Treatment of Distal Radius Fractures, Watters WC, Sanders JO et al (2014) The American Academy of Orthopaedic Surgeons Appropriate Use Criteria on the treatment of distal radius fractures. J Bone Joint Surg Am 96:160–161. doi: 10.2106/JBJS.M.01314 CrossRefGoogle Scholar
  10. 10.
    Herzberg G (2013) Acute distal radius fracture: PAF analysis. J Wrist Surg 2:95–96. doi: 10.1055/s-0033-1336013 CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Rikli DA, Regazzoni P (1996) Fractures of the distal end of the radius treated by internal fixation and early function. A preliminary report of 20 cases. J Bone Joint Surg (Br) 78:588–592Google Scholar
  12. 12.
    Rikli DA, Campbell D (2007) Distal radius and wrist. In: Ruedi T, Buckley R, Moran C (eds) AO principles of fracture management, 2nd edn. AO Publishing, Stavos, pp 657–677Google Scholar
  13. 13.
    Egol K, Koval K, Zuckerman J (2010) Distal radius. In: Egol K, Koval K, Zuckerman J (eds) Handbook of fractures, 4th edn. Lippincott Williams & Wilkins, Philadelphia, pp 269–280Google Scholar
  14. 14.
    Sauerbier M, Unglaub F (2009) Anatomy and biomechanics of forearm rotation. In: Slutsky D, Osterman A (eds) Fractures and injuries of the distal radius and carpus: the cutting edge, 1st edn. Saunders, Philadelphia, pp 285–296CrossRefGoogle Scholar
  15. 15.
    Palmer AK (1987) The distal radioulnar joint. Anatomy, biomechanics, and triangular fibrocartilage complex abnormalities. Hand Clin 3:31–40PubMedGoogle Scholar
  16. 16.
    Stoller D, Li A, Lichtman D, Brody G (2007) The wrist and hand. In: Stoller D (ed) Magnetic resonance imaging in orthopedic sports medicine, 3rd edn. Lippincott Williams & Wilkins, Philadelphia, pp 1627–1846Google Scholar
  17. 17.
    Resnick D (2002) Internal derangements of joints. In: Resnick D (ed) Diagnosis of bone and joint disorders, 4th edn. Saunders, Philadelphia, pp 3019–3375Google Scholar
  18. 18.
    Goldfarb CA, Yin Y, Gilula LA et al (2001) Wrist fractures: what the clinician wants to know. Radiology 219:11–28. doi: 10.1148/radiology.219.1.r01ap1311 CrossRefPubMedGoogle Scholar
  19. 19.
    Ekenstam F (1998) Osseous anatomy and articular relationships about the distal ulna. Hand Clin 14:161–164PubMedGoogle Scholar
  20. 20.
    Squires JH, England E, Mehta K, Wissman RD (2014) The role of imaging in diagnosing diseases of the distal radioulnar joint, triangular fibrocartilage complex, and distal ulna. AJR Am J Roentgenol 203:146–153. doi: 10.2214/AJR.13.11573 CrossRefPubMedGoogle Scholar
  21. 21.
    Mulford JS, Axelrod TS (2007) Traumatic injuries of the distal radioulnar joint. Orthop Clin North Am 38(289–297):vii. doi: 10.1016/j.ocl.2007.03.007 Google Scholar
  22. 22.
    Bruno M, Weissman B, Kransdorf M, et al. (2013) ACR Appropriateness Criteria®: acute hand and wrist trauma.Google Scholar
  23. 23.
    Kiuru MJ, Haapamaki VV, Koivikko MP, Koskinen SK (2004) Wrist injuries; diagnosis with multidetector CT. Emerg Radiol 10:182–185. doi: 10.1007/s10140-003-0321-4 CrossRefPubMedGoogle Scholar
  24. 24.
    Rodríguez-Merchán EC (1998) Management of comminuted fractures of the distal radius in the adult. Conservative or surgical? Clin Orthop 53–62.Google Scholar
  25. 25.
    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 Joint Surg Am 88:1315–1323. doi: 10.2106/JBJS.E.00686 CrossRefPubMedGoogle Scholar
  26. 26.
    Cole RJ, 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 22:792–800CrossRefGoogle Scholar
  27. 27.
    Rozental TD, Bozentka DJ, Katz MA et al (2001) Evaluation of the sigmoid notch with computed tomography following intra-articular distal radius fracture. J Hand Surg 26:244–251. doi: 10.1053/jhsu.2001.22930 CrossRefGoogle Scholar
  28. 28.
    Geijer M, El-Khoury GY (2006) MDCT in the evaluation of skeletal trauma: principles, protocols, and clinical applications. Emerg Radiol 13:7–18. doi: 10.1007/s10140-006-0509-5 CrossRefPubMedGoogle Scholar
  29. 29.
    Balci A, Basara I, Çekdemir EY et al (2015) Wrist fractures: sensitivity of radiography, prevalence, and patterns in MDCT. Emerg Radiol 22:251–256. doi: 10.1007/s10140-014-1278-1 CrossRefPubMedGoogle Scholar
  30. 30.
    Federman D, Kavanagh E, Morrison W, Koulouris G (2009) Role of advanced imaging in distal radius fractures. In: Slutsky D, Osterman A (eds) Fractures and injuries of the distal radius and carpus: the cutting edge, 1st edn. Saunders, Philadelphia, pp 1–6, W1 CrossRefGoogle Scholar
  31. 31.
    Ginde AA, Foianini A, Renner DM et al (2008) Availability and quality of computed tomography and magnetic resonance imaging equipment in U.S. emergency departments. Acad Emerg Med Off J Soc Acad Emerg Med 15:780–783. doi: 10.1111/j.1553-2712.2008.00192.x CrossRefGoogle Scholar
  32. 32.
    Levin DC, Rao VM, Parker L, Frangos AJ (2014) Continued growth in emergency department imaging is bucking the overall trends. J Am Coll Radiol JACR 11:1044–1047. doi: 10.1016/j.jacr.2014.07.008 CrossRefPubMedGoogle Scholar
  33. 33.
    Loredo RA, Sorge DG, Garcia G (2005) Radiographic evaluation of the wrist: a vanishing art. Semin Roentgenol 40:248–289CrossRefPubMedGoogle Scholar
  34. 34.
    Jackson ME, Henderson JE (2010) Following trauma, should adult wrist radiographic examinations be two or three projections? Emerg Radiol 17:87–93. doi: 10.1007/s10140-009-0836-4 CrossRefPubMedGoogle Scholar
  35. 35.
    McQueen MM, Hajducka C, Court-Brown CM (1996) Redisplaced unstable fractures of the distal radius: a prospective randomised comparison of four methods of treatment. J Bone Joint Surg (Br) 78:404–409Google Scholar
  36. 36.
    Watanabe K, Nakamura R, Horii E, Miura T (1993) Biomechanical analysis of radial wedge osteotomy for the treatment of Kienböck’s disease. J Hand Surg 18:686–690. doi: 10.1016/0363-5023(93)90319-X CrossRefGoogle Scholar
  37. 37.
    Park MJ, Cooney WP, Hahn ME et al (2002) The effects of dorsally angulated distal radius fractures on carpal kinematics. J Hand Surg 27:223–232CrossRefGoogle Scholar
  38. 38.
    Prommersberger K-J, Froehner SC, Schmitt RR, Lanz UB (2004) Rotational deformity in malunited fractures of the distal radius. J Hand Surg 29:110–115CrossRefGoogle Scholar
  39. 39.
    Lawler E, Adams BD (2007) Reconstruction for DRUJ instability. Hand N Y N 2:123–126. doi: 10.1007/s11552-007-9034-6 CrossRefGoogle Scholar
  40. 40.
    Ross M, Di Mascio L, Peters S et al (2014) Defining residual radial translation of distal radius fractures: a potential cause of distal radioulnar joint instability. J Wrist Surg 3:22–29. doi: 10.1055/s-0033-1357758 CrossRefPubMedPubMedCentralGoogle Scholar
  41. 41.
    Pogue DJ, Viegas SF, Patterson RM et al (1990) Effects of distal radius fracture malunion on wrist joint mechanics. J Hand Surg 15:721–727CrossRefGoogle Scholar
  42. 42.
    Nakamura R, Horii E, Imaeda T et al (1995) Distal radioulnar joint subluxation and dislocation diagnosed by standard roentgenography. Skeletal Radiol 24:91–94CrossRefPubMedGoogle Scholar
  43. 43.
    Mino DE, Palmer AK, Levinsohn EM (1983) The role of radiography and computerized tomography in the diagnosis of subluxation and dislocation of the distal radioulnar joint. J Hand Surg 8:23–31CrossRefGoogle Scholar
  44. 44.
    Welling RD, Jacobson JA, Jamadar DA et al (2008) MDCT and radiography of wrist fractures: radiographic sensitivity and fracture patterns. AJR Am J Roentgenol 190:10–16. doi: 10.2214/AJR.07.2699 CrossRefPubMedGoogle Scholar
  45. 45.
    Pruitt DL, Gilula LA, Manske PR, Vannier MW (1994) Computed tomography scanning with image reconstruction in evaluation of distal radius fractures. J Hand Surg 19:720–727. doi: 10.1016/0363-5023(94)90174-0 CrossRefGoogle Scholar
  46. 46.
    Metz VM, Gilula LA (1993) Imaging techniques for distal radius fractures and related injuries. Orthop Clin North Am 24:217–228PubMedGoogle Scholar
  47. 47.
    Nakamura R, Horii E, Imaeda T, Nakao E (1996) Criteria for diagnosing distal radioulnar joint subluxation by computed tomography. Skeletal Radiol 25:649–653CrossRefPubMedGoogle Scholar
  48. 48.
    Nakamura R, Horii E, Tanaka Y et al (1989) Three-dimensional CT imaging for wrist disorders. J Hand Surg Edinb Scotl 14:53–58CrossRefGoogle Scholar
  49. 49.
    Frykman G (1967) Fracture of the distal radius including sequelae—shoulder-hand-finger syndrome, disturbance in the distal radio-ulnar joint and impairment of nerve function. A clinical and experimental study. Acta Orthop Scand Suppl 108:3+Google Scholar
  50. 50.
    Melone CP (1984) Articular fractures of the distal radius. Orthop Clin North Am 15:217–236PubMedGoogle Scholar
  51. 51.
    Cooney WP (1993) Fractures of the distal radius. A modern treatment-based classification. Orthop Clin North Am 24:211–216PubMedGoogle Scholar
  52. 52.
    Newey ML, Ricketts D, Roberts L (1993) The AO classification of long bone fractures: an early study of its use in clinical practice. Injury 24:309–312CrossRefPubMedGoogle Scholar
  53. 53.
    Fernández DL (1993) Fractures of the distal radius: operative treatment. Instr Course Lect 42:73–88PubMedGoogle Scholar
  54. 54.
    Naqvi SGA, Reynolds T, Kitsis C (2009) Interobserver reliability and intraobserver reproducibility of the Fernandez classification for distal radius fractures. J Hand Surg Eur Vol 34:483–485. doi: 10.1177/1753193408101667 CrossRefPubMedGoogle Scholar
  55. 55.
    Andersen DJ, Blair WF, Steyers CM et al (1996) Classification of distal radius fractures: an analysis of interobserver reliability and intraobserver reproducibility. J Hand Surg 21:574–582CrossRefGoogle Scholar
  56. 56.
    Flikkilä T, Nikkola-Sihto A, Kaarela O et al (1998) Poor interobserver reliability of AO classification of fractures of the distal radius. Additional computed tomography is of minor value. J Bone Joint Surg Br 80:670–672CrossRefPubMedGoogle Scholar
  57. 57.
    Kural C, Sungur I, Kaya I et al (2010) Evaluation of the reliability of classification systems used for distal radius fractures. Orthopedics 33:801. doi: 10.3928/01477447-20100924-14 PubMedGoogle Scholar
  58. 58.
    Diaz-Garcia RJ, Chung KC (2012) Common myths and evidence in the management of distal radius fractures. Hand Clin 28:127–133. doi: 10.1016/j.hcl.2012.02.005 CrossRefPubMedPubMedCentralGoogle Scholar
  59. 59.
    Sanders KM, Seeman E, Ugoni AM et al (1999) Age- and gender-specific rate of fractures in Australia: a population-based study. Osteoporos Int J Establ Result Coop Eur Found Osteoporos Natl Osteoporos Found USA 10:240–247. doi: 10.1007/s001980050222 CrossRefGoogle Scholar
  60. 60.
    Wolfe S (2011) Distal radius fractures. In: Wolfe S, Hotchkiss R, Pederson W, Kozin S (eds) Green's operative hand surgery, 6th edn. Elsevier, Philadelphia, pp 561–638CrossRefGoogle Scholar
  61. 61.
    Stewart HD, Innes AR, Burke FD (1984) Functional cast-bracing for Colles’ fractures. A comparison between cast-bracing and conventional plaster casts. J Bone Joint Surg Br 66:749–753PubMedGoogle Scholar
  62. 62.
    Hove LM (1994) Delayed rupture of the thumb extensor tendon. A 5-year study of 18 consecutive cases. Acta Orthop Scand 65:199–203CrossRefPubMedGoogle Scholar
  63. 63.
    Stoller D, Tirman P, Bredella M et al (2004) Wrist and hand. In: Stoller D, Tirman P, Bredella M (eds) Diagnostic imaging: orthopaedics, 1st edn, 3. Amirsys, Salt Lake City, pp 1–105Google Scholar
  64. 64.
    Edwards H (1926) The mechanism and treatment of backfire fracture. J Bone Jt Surg Am 8:701–717Google Scholar
  65. 65.
    Payandeh JB, McKee MD (2007) External fixation of distal radius fractures. Orthop Clin North Am 38(187–192):vi. doi: 10.1016/j.ocl.2007.02.005 Google Scholar
  66. 66.
    Dias J (2009) Nonoperative treatment of distal radius fractures. In: Slutsky D, Osterman A (eds) Fractures and injuries of the distal radius and carpus: the cutting edge, 1st edn. Saunders, Philadelphia, pp 11–15CrossRefGoogle Scholar
  67. 67.
    Wichlas F, Haas NP, Lindner T, Tsitsilonis S (2013) Closed reduction of distal radius fractures: does instability mean irreducibility? Arch Orthop Trauma Surg 133:1073–1078. doi: 10.1007/s00402-013-1758-x CrossRefPubMedGoogle Scholar
  68. 68.
    Lafontaine M, Hardy D, Delince P (1989) Stability assessment of distal radius fractures. Injury 20:208–210CrossRefPubMedGoogle Scholar
  69. 69.
    Gartland JJ, Werley CW (1951) Evaluation of healed Colles’ fractures. J Bone Joint Surg Am 33-A:895–907PubMedGoogle Scholar
  70. 70.
    Knirk JL, Jupiter JB (1986) Intra-articular fractures of the distal end of the radius in young adults. J Bone Joint Surg Am 68:647–659PubMedGoogle Scholar
  71. 71.
    Karantana A, Downing ND, Forward DP et al (2013) Surgical treatment of distal radial fractures with a volar locking plate versus conventional percutaneous methods: a randomized controlled trial. J Bone Joint Surg Am 95:1737–1744. doi: 10.2106/JBJS.L.00232 CrossRefPubMedGoogle Scholar
  72. 72.
    Lucas GL, Fejfar ST (1998) Complications in internal fixation of the distal radius. J Hand Surg 23:1117CrossRefGoogle Scholar
  73. 73.
    Wilcke MKT, Abbaszadegan H, Adolphson PY (2011) Wrist function recovers more rapidly after volar locked plating than after external fixation but the outcomes are similar after 1 year. Acta Orthop 82:76–81. doi: 10.3109/17453674.2011.552781 CrossRefPubMedPubMedCentralGoogle Scholar
  74. 74.
    Egol K, Walsh M, Tejwani N et al (2008) Bridging external fixation and supplementary Kirschner-wire fixation versus volar locked plating for unstable fractures of the distal radius: a randomised, prospective trial. J Bone Joint Surg (Br) 90:1214–1221. doi: 10.1302/0301-620X.90B9.20521 CrossRefGoogle Scholar

Copyright information

© American Society of Emergency Radiology 2015

Authors and Affiliations

  1. 1.Department of RadiologyBrigham and Women’s Hospital, Harvard Medical SchoolBostonUSA
  2. 2.Department of RadiologyWilliam S. Middleton Memorial Veterans HospitalMadisonUSA
  3. 3.Department of Orthopedic SurgeryBrigham and Women’s Hospital, Harvard Medical SchoolBostonUSA

Personalised recommendations