Abstract
Distal Radius fractures (DRF) are one of the most common injuries in the upper extremity and incidence is expected to rise due to a growing elderly population. The complex decision to treat patients operatively or conservatively depends on a large variety of parameters which have to be considered. No unanimous consensus has been reached yet, which operative approach and fixation technique would produce the best postoperative functional results with lowest complication rates. This article addresses the available evidence for indications, approaches, reduction, and fixation techniques in treating DRF.
Similar content being viewed by others
References
MacIntyre NJ, Dewan N (2016) Epidemiology of distal radius fractures and factors predicting risk and prognosis. J Hand Ther 29:136–145. https://doi.org/10.1016/j.jht.2016.03.003
Schermann H, Kadar A, Dolkart O et al (2018) Repeated closed reduction attempts of distal radius fractures in the emergency department. Arch Orthop Trauma Surg 138:591–596. https://doi.org/10.1007/s00402-018-2904-2
Weil NL, El Moumni M, Rubinstein SM et al (2017) Routine follow-up radiographs for distal radius fractures are seldom clinically substantiated. Arch Orthop Trauma Surg 137:1187–1191. https://doi.org/10.1007/s00402-017-2743-6
Quadlbauer S, Pezzei C, Hintringer W et al (2018) Clinical examination of the distal radioulnar joint. Orthopade 47:628–636
Hohendorff B, Knappwerth C, Franke J et al (2018) Pronator quadratus repair with a part of the brachioradialis muscle insertion in volar plate fixation of distal radius fractures: a prospective randomised trial. Arch Orthop Trauma Surg 138:1479–1485. https://doi.org/10.1007/s00402-018-2999-5
Rotman D, Schermann H, Kadar A (2019) Displaced distal radius fracture presenting with neuropraxia of the dorsal cutaneous branch of the ulnar nerve (DCBUN). Arch Orthop Trauma Surg 139:1021–1023. https://doi.org/10.1007/s00402-019-03191-x
Suda AJ, Schamberger CT, Viergutz T (2019) Donor site complications following anterior iliac crest bone graft for treatment of distal radius fractures. Arch Orthop Trauma Surg 139:423–428. https://doi.org/10.1007/s00402-018-3098-3
Schlickum L, Quadlbauer S, Pezzei C et al (2018) Three-dimensional kinematics of the flexor pollicis longus tendon in relation to the position of the FPL plate and distal radius width. Arch Orthop Trauma Surg. https://doi.org/10.1007/s00402-018-3081-z
Gabl M, Arora R, Klauser AS, Schmidle G (2016) Characteristics of secondary arthrofibrosis after intra-articular distal radius fracture. Arch Orthop Trauma Surg 136:1181–1188. https://doi.org/10.1007/s00402-016-2490-0
Quadlbauer S, Pezzei C, Jurkowitsch J et al (2020) Rehabilitation after distal radius fractures: is there a need for immobilization and physiotherapy? Arch Orthop Trauma Surg. https://doi.org/10.1007/s00402-020-03367-w
Figl M, Weninger P, Liska M et al (2009) Volar fixed-angle plate osteosynthesis of unstable distal radius fractures: 12 months results. Arch Orthop Trauma Surg 129:661–669. https://doi.org/10.1007/s00402-009-0830-z
Esenwein P, Sonderegger J, Gruenert J et al (2013) Complications following palmar plate fixation of distal radius fractures: a review of 665 cases. Arch Orthop Trauma Surg 133:1155–1162
Quadlbauer S, Pezzei C, Jurkowitsch J et al (2018) Early complications and radiological outcome after distal radius fractures stabilized by volar angular stable locking plate. Arch Orthop Trauma Surg 138:1773–1782. https://doi.org/10.1007/s00402-018-3051-5
Weschenfelder W, Friedel R, Hofmann GO, Lenz M (2019) Acute atraumatic carpal tunnel syndrome due to flexor tendon rupture following palmar plate osteosynthesis in a patient taking rivaroxaban. Arch Orthop Trauma Surg 139:435–438. https://doi.org/10.1007/s00402-019-03116-8
Gologan RE, Koeck M, Suda AJ, Obertacke U (2019) %3e 10-year outcome of dislocated radial fractures with concomitant intracarpal lesions as proven by MRI and CT. Arch Orthop Trauma Surg 139:877–881. https://doi.org/10.1007/s00402-019-03186-8
Gologan R, Ginter VM, Haeffner A et al (2016) 1-Year outcome of concomitant intracarpal lesions in patients with dislocated distal radial fractures: a systematic assessment of 78 distal radial fractures. Arch Orthop Trauma Surg 136:425–432. https://doi.org/10.1007/s00402-015-2357-9
Lameijer CM, ten Duis HJ, van Dusseldorp I et al (2017) Prevalence of posttraumatic arthritis and the association with outcome measures following distal radius fractures in non-osteoporotic patients: a systematic review. Arch Orthop Trauma Surg 137:1499–1513. https://doi.org/10.1007/s00402-017-2765-0
Lameijer CM, Ten Duis HJ, Vroling D et al (2018) Prevalence of posttraumatic arthritis following distal radius fractures in non-osteoporotic patients and the association with radiological measurements, clinician and patient-reported outcomes. Arch Orthop Trauma Surg 138:1699–1712. https://doi.org/10.1007/s00402-018-3046-2
Erhart S, Toth S, Kaiser P et al (2018) Comparison of volarly and dorsally displaced distal radius fracture treated by volar locking plate fixation. Arch Orthop Trauma Surg 138:879–885. https://doi.org/10.1007/s00402-018-2925-x
Quadlbauer S, Pezzei C, Jurkowitsch J et al (2016) Early rehabilitation of distal radius fractures stabilized by volar locking plate: a prospective randomized pilot study. J Wrist Surg 06:102–112. https://doi.org/10.1055/s-0036-1587317
Quadlbauer S, Leixnering M, Jurkowitsch J et al (2017) Volar radioscapholunate arthrodesis and distal scaphoidectomy after malunited distal radius fractures. J Hand Surg Am 42:754.e1–754.e8. https://doi.org/10.1016/j.jhsa.2017.05.031
Quadlbauer S, Pezzei C, Jurkowitsch J et al (2017) Spontaneous radioscapholunate fusion after septic arthritis of the wrist: a case report. Arch Orthop Trauma Surg 137:579–584. https://doi.org/10.1007/s00402-017-2659-1
Krimmer H, Unglaub F, Langer MF, Spies CK (2016) The distal radial decompression osteotomy for ulnar impingement syndrome. Arch Orthop Trauma Surg 136:143–148. https://doi.org/10.1007/s00402-015-2363-y
Keuchel T, Quadlbauer S, Jurkowitsch J et al (2020) Salvage procedure after malunited distal radius fractures and management of pain and stiffness. Arch Orthop Trauma Surg. https://doi.org/10.1007/s00402-020-03369-8
Vannabouathong C, Hussain N, Guerra-Farfan E, Bhandari M (2019) Interventions for distal radius fractures. J Am Acad Orthop Surg 27:e596–e605. https://doi.org/10.5435/JAAOS-D-18-00424
Le ZS, Kan SL, Su LX, Wang B (2015) Meta-analysis for dorsally displaced distal radius fracture fixation: volar locking plate versus percutaneous Kirschner wires. J Orthop Surg Res. https://doi.org/10.1186/s13018-015-0252-2
Wei DH, Raizman NM, Bottino CJ et al (2009) Unstable distal radial fractures treated with external fixation, a radial column plate, or a volar plate: a prospective randomized trial. J Bone Jt Surg 91:1568–1577. https://doi.org/10.2106/JBJS.H.00722
Rubin G, Orbach H, Chezar A, Rozen N (2017) Treatment of physeal fractures of the distal radius by volar intrafocal Kapandji method: surgical technique. Arch Orthop Trauma Surg 137:49–54. https://doi.org/10.1007/s00402-016-2592-8
Foldager-Jensen AD (2014) The clinical dilemma: nonoperative or operative treatment. In: Hove LM, Lindau T, Hølmer P (eds) Distal radius fractures. Springer-Verlag, Berlin, pp 109–114
Arora R, Lutz M, Deml C et al (2011) A prospective randomized trial comparing nonoperative treatment with volar locking plate fixation for displaced and unstable distal radial fractures in patients sixty-five years of age and older. J Bone Jt Surg Am 93:2146–2153. https://doi.org/10.2106/JBJS.J.01597
Mackenney PJ, McQueen MM, Elton R (2006) Prediction of instability in distal radial fractures. J Bone Jt Surg 88:1944. https://doi.org/10.2106/JBJS.D.02520
Rosenauer R, Pezzei C, Quadlbauer S et al (2020) Complications after operatively treated distal radius fractures. Arch Orthop Trauma Surg. https://doi.org/10.1007/s00402-020-03372-z
Makhni EC, Ewald TJ, Kelly S, Day CS (2008) Effect of patient age on the radiographic outcomes of distal radius fractures subject to nonoperative treatment. J Hand Surg Am 33:1301–1308. https://doi.org/10.1016/j.jhsa.2008.04.031
Lichtman DM, Bindra RR, Boyer MI et al (2010) Treatment of distal radius fractures. J Am Acad Orthop Surg 18:180–189
Lafontaine M, Hardy D, Delince P (1989) Stability assessment of distal radius fractures. Injury 20:208–210
Tahririan MA, Javdan M, Nouraei MH, Dehghani M (2013) Evaluation of instability factors in distal radius fractures. J Res Med Sci 18:892–896
Walenkamp MMJ, Aydin S, Mulders MAM et al (2016) Predictors of unstable distal radius fractures: a systematic review and meta-analysis. J Hand Surg 41:501–515. https://doi.org/10.1177/1753193415604795
Protopsaltis TS, Ruch DS (2008) Volar approach to distal radius fractures. J Hand Surg Am 33:958–965. https://doi.org/10.1016/j.jhsa.2008.04.018
Diaz-Garcia RJ, Oda T, Shauver MJ, Chung KC (2011) A systematic review of outcomes and complications of treating unstable distal radius fractures in the elderly. J Hand Surg Am 36:824–835. https://doi.org/10.1016/j.jhsa.2011.02.005
Egol KA, Walsh M, Romo-Cardoso S et al (2010) Distal radial fractures in the elderly: operative compared with nonoperative treatment. J Bone Jt Surg Am 92:1851–1857. https://doi.org/10.2106/JBJS.I.00968
Chen Y, Chen X, Li Z et al (2016) Safety and efficacy of operative versus nonsurgical management of distal radius fractures in elderly patients: a systematic review and meta-analysis. J Hand Surg Am 41:404–413. https://doi.org/10.1016/j.jhsa.2015.12.008
Song J, Yu A-X, Li Z-H (2015) Comparison of conservative and operative treatment for distal radius fracture: a meta-analysis of randomized controlled trials. Int J Clin Exp Med 8:17023–17035
Unglaub F, Langer MF, Hohendorff B et al (2017) Distale radiusfraktur. Orthopade 46:93–110. https://doi.org/10.1007/s00132-016-3347-5
Bentohami A, De Burlet K, De Korte N et al (2014) Complications following volar locking plate fixation for distal radial fractures: a systematic review. J Hand Surg Eur 39:745–754. https://doi.org/10.1177/1753193413511936
Fujitani R, Omokawa S, Iida A et al (2012) Reliability and clinical importance of teardrop angle measurement in intra-articular distal radius fracture. J Hand Surg Am 37:454–459. https://doi.org/10.1016/j.jhsa.2011.10.056
Medoff RJ (2005) Essential radiographic evaluation for distal radius fractures. Hand Clin 21:279–288. https://doi.org/10.1016/j.hcl.2005.02.008
Surke C, Raschke M, Langer M (2012) Distale radiusfraktur: versorgungsstrategien beim älteren menschen. OP J 28:256–260. https://doi.org/10.1055/s-0032-1327997
Jeffrey Cole R, 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 Am 22:792–800. https://doi.org/10.1016/S0363-5023(97)80071-8
Knirk JL, Jupiter JB (1986) Intra-articular fractures of the distal end of the radius in young adults. J Bone Jt Surg Am 68:647–659
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 Jt Surg 88:1315–1323. https://doi.org/10.2106/JBJS.E.00686
Schmutz B, Kmiec S, Wullschleger ME et al (2017) 3D Computer graphical anatomy study of the femur: a basis for a new nail design. Arch Orthop Trauma Surg 137:321–331. https://doi.org/10.1007/s00402-016-2621-7
Hintringer W, Rosenauer R, Pezzei C et al (2020) Biomechanical considerations on a CT based treatment-oriented classification in radius fractures. Arch Orthop Trauma Surg. https://doi.org/10.1007/s00402-020-03405-7
Handoll HHG, Elliott J (2015) Rehabilitation for distal radial fractures in adults. Cochrane Database Syst Rev 9:CD003324. https://doi.org/10.1002/14651858.CD003324.pub3
Conti Mica MA, Bindra R, Moran SL (2017) Anatomic considerations when performing the modified Henry approach for exposure of distal radius fractures. J Orthop 14:104–107. https://doi.org/10.1016/j.jor.2016.10.015
Ilyas AM (2011) Surgical approaches to the distal radius. Hand 6:8–17. https://doi.org/10.1007/s11552-010-9281-9
Jupiter JB, Fernandez DL, Toh CL et al (1996) Operative treatment of volar intra-articular fractures of the distal end of the radius. J Bone Jt Surg 78:1817–1828. https://doi.org/10.2106/00004623-199612000-00004
Orbay JL, Fernandez DL (2002) Volar fixation for dorsally displaced fractures of the distal radius: a preliminary report. J Hand Surg Am 27:205–215. https://doi.org/10.1053/jhsu.2002.32081
Henry AK (1927) Complete exposure of the radius. Exposures of long bones and other surgical methods. John Wiley and Sons Ltd., New Jersey, pp 9–12
Orbay J, Badia A, Khoury RK et al (2004) Volar fixed-angle fixation of distal radius fractures: the DVR plate. Tech Hand Up Extrem Surg 8:142–148. https://doi.org/10.1097/01.bth.0000126570.82826.0a
Chirpaz-Cerbat J-M, Ruatti S, Houillon C, Ionescu S (2011) Dorsally displaced distal radius fractures treated by fixed-angle volar plating: Grip and pronosupination strength recovery. A prospective study. Orthop Traumatol Surg Res 97:465–470. https://doi.org/10.1016/j.otsr.2011.01.016
Mulders MAM, Walenkamp MMJ, Bos FJME et al (2017) Repair of the pronator quadratus after volar plate fixation in distal radius fractures: a systematic review. Strateg Trauma Limb Reconstr 12:1–8. https://doi.org/10.1007/s11751-017-0288-4
Alluri RK, Hill JR, Ghiassi A (2016) Distal radius fractures: approaches, indications, and techniques. J Hand Surg Am 41:845–854
Mares O, Coulomb R, Lazerges C et al (2016) Surgical exposures for distal radius fractures. Hand Surg Rehabil 35:39–43
Spies CKG, Langer M, Müller L et al (2020) Distal radioulnar joint instability – current concepts of treatment. Arch Orthop Trauma Surg. https://doi.org/10.1007/s00402-020-03371-0
Disseldorp DJG, Hannemann PFW, Poeze M, Brink PRG (2016) Dorsal or volar plate fixation of the distal radius: does the complication rate help us to choose? J Wrist Surg 05:202–210. https://doi.org/10.1055/s-0036-1571842
Simic PM, Robison J, Gardner MJ et al (2006) Treatment of distal radius fractures with a low-profile dorsal plating system: an outcomes assessment. J Hand Surg Am. https://doi.org/10.1016/j.jhsa.2005.10.016
Kamath AF, Zurakowski D, Day CS (2006) Low-profile dorsal plating for dorsally angulated distal radius fractures: an outcomes study. J Hand Surg Am. https://doi.org/10.1016/j.jhsa.2006.05.008
Wei J, Yang TB, Luo W et al (2013) Complications following dorsal versus volar plate fixation of distal radius fracture: a meta-analysis. J Int Med Res. https://doi.org/10.1177/0300060513476438
Kumar S, Khan AN, Sonanis SV (2016) Radiographic and functional evaluation of low profile dorsal versus volar plating for distal radius fractures. J Orthop. https://doi.org/10.1016/j.jor.2016.06.017
Abe Y, Tokunaga S, Moriya T (2017) Management of intra-articular distal radius fractures: volar or dorsal locking plate which has fewer complications? Hand. https://doi.org/10.1177/1558944716675129
Kastenberger T, Kaiser P, Schwendinger P et al (2020) Arthroscopic assisted treatment of distal radius fractures and concomitant injuries. Arch Orthop Trauma. https://doi.org/10.1007/s00402-020-03373-y
Kapandji A (1976) Internal fixation by double intrafocal plate. Functional treatment of non articular fractures of the lower end of the radius. Ann Chir 30:903–908
Orbay JL, Badia A, Indriago IR et al (2001) The extended flexor carpi radialis approach: a new perspective for the distal radius fracture. Tech Hand Up Extrem Surg. https://doi.org/10.1097/00130911-200112000-00004
Kaiser P, Gruber H, Loth F et al (2019) Positioning of a volar locking plate with a central flexor pollicis longus tendon notch in distal radius fractures. J Wrist Surg. https://doi.org/10.1055/s-0039-1694718
Spies CK, Müller LP, Oppermann J et al (2014) Die Instabilität des distalen Radioulnargelenks-Zur Wertigkeit klinischer und röntgenologischer Testverfahren-eine Literaturü bersicht. Handchir Mikrochir Plast Chir 46:137–150. https://doi.org/10.1055/s-0033-1363662
Spies CK, Hahn P, Unglaub F et al (2015) Instability of the distal radioulnar joint: treatment options for ulnar lesions of the triangular fibrocartilage complex. Unfallchirurg. https://doi.org/10.1007/s00113-015-0044-5
Kirchberger MC, Unglaub F, Mühldorfer-Fodor M et al (2015) Update TFCC: histology and pathology, classification, examination and diagnostics. Arch Orthop Trauma Surg 135:427–437. https://doi.org/10.1007/s00402-015-2153-6
Acknowledgements
We thank Rose-Marie Sedlacek for proof reading this article. Without her help, this English publication would not have been possible.
Funding
This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors, their immediate families, and any research foundations with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article.
Ethical approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Leixnering, M., Rosenauer, R., Pezzei, C. et al. Indications, surgical approach, reduction, and stabilization techniques of distal radius fractures. Arch Orthop Trauma Surg 140, 611–621 (2020). https://doi.org/10.1007/s00402-020-03365-y
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00402-020-03365-y