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.
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