Abstract
There is no consensus as to the most appropriate treatment of distal radius fractures in older patients, particularly when the fractures are comminuted and intra-articular patients with poor bone quality. Oftentimes, these fractures are considered non-reconstructable fractures. Total wrist arthroplasty has evolved as a viable treatment for reconstruction of the wrist. Applying principles that have been successful in the hip, shoulder, and elbow replacements, some surgeons have started managing complex, intra-articular distal radius fractures in older patients with poor bone quality with arthroplasties, either distal radial hemiarthroplasties or total wrist arthroplasties. All of the current evidence pertaining to the use of wrist arthroplasty for the management of fractures is level IV evidence, most of which comes out of Europe where implants that are necessarily available in all countries are available. The majority of the available evidence is on the use of distal radial hemiarthroplasties. The current evidence suggests that hemiarthroplasty is a viable treatment option in select patients, though in general, the ultimate flexion-extension arc of motion obtained is less than that obtained by other available treatments, such as simple closed reduction and casting. Total wrist arthroplasty may have better outcomes, though the evidence is limited to only a couple of cases. Ultimately, a prospective, randomized controlled trial comparing total wrist arthroplasty to other treatment options for comminuted distal radius fractures in older patients is needed. Total wrist arthroplasty may expedite patients’ return to their previous level of function.
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsReferences
Ritt MJ, Stuart PR, Naggar L, Beckenbaugh RD. The early history of arthroplasty of the wrist. From amputation to total wrist implant. J Hand Surg Br. 1994;19(6):778–82.
Roux JL. Replacement and resurfacing prosthesis of the distal radius: a new therapeutic concept. Chir Main. 2009;28(1):10–7.
Vergnenegre G, Mabit C, Charissoux JL, Arnaud JP, Marcheix PS. Treatment of comminuted distal radius fractures by resurfacing prosthesis in elderly patients. Chir Main. 2014;33(2):112–7.
Ichihara S, Diaz JJ, Peterson B, Facca S, Bodin F, Liverneaux P. Distal radius isoelastic resurfacing prosthesis: a preliminary report. J Wrist Surg. 2015;4(3):150–5.
Halim A, Weiss AC. Total wrist arthroplasty. J Hand Surg Am. 2017;42(3):198–209.
Herzberg G, Burnier M, Marc A, Izem Y. Primary wrist hemiarthroplasty for irreparable distal radius fracture in the independent elderly. J Wrist Surg. 2015;4(3):156–63.
Culp RW, Bachoura A, Gelman SE, Jacoby SM. Proximal row carpectomy combined with wrist hemiarthroplasty. J Wrist Surg. 2012;1(1):39–46.
Adams BD. Wrist arthroplasty: partial and total. Hand Clin. 2013;29(1):79–89.
Adams BD, Lawler EA, Kuhl TL. Distal radius hemiarthroplasty. J Wrist Surg. 2016;5(3):217–21.
Adams BD. Total wrist arthroplasty for posttraumatic arthritis with radius deformity. J Wrist Surg. 2015;4(3):164–8.
Gaspar MP, Lou J, Kane PM, Jacoby SM, Osterman AL, Culp RW. Complications following partial and total wrist arthroplasty: a single-center retrospective review. J Hand Surg Am. 2016;41(1):47–53.e4.
Sagerfors M, Gupta A, Brus O, Rizzo M, Pettersson K. Patient related functional outcome after total wrist arthroplasty: a single center study of 206 cases. Hand Surg. 2015;20(1):81–7.
Schmidt I. Can total wrist arthroplasty be an option for treatment of highly comminuted distal radius fracture in selected patients? Preliminary experience with two cases. Case Rep Orthop. 2015;2015:380935.
Diaz-Garcia RJ, Oda T, Shauver MJ, Chung KC. A systematic review of outcomes and complications of treating unstable distal radius fractures in the elderly. J Hand Surg Am. 2011;36(5):824–35.e2.
Chung KC, Squitieri L, Kim HM. Comparative outcomes study using the volar locking plating system for distal radius fractures in both young adults and adults older than 60 years. J Hand Surg Am. 2008;33(6):809–19.
Herzberg G, Izem Y, Al Saati M, Plotard F. “PAF” analysis of acute distal radius fractures in adults. Preliminary results. Chir Main. 2010;29(4):231–5.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2018 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Morrell, N.T., Weiss, AP.C. (2018). Total Wrist Arthroplasty for Treatment of Distal Radius Fractures. In: Borrelli Jr., J., Anglen, J. (eds) Arthroplasty for the Treatment of Fractures in the Older Patient. Springer, Cham. https://doi.org/10.1007/978-3-319-94202-5_6
Download citation
DOI: https://doi.org/10.1007/978-3-319-94202-5_6
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-94201-8
Online ISBN: 978-3-319-94202-5
eBook Packages: MedicineMedicine (R0)