Intra-articular Dista Radius Fracture

Intra-articular Distal Radius Fracture: plates/approaches

Adam C Watts Consultant Elbow and Upper Limb Surgeon, Wrightington

Hospital

Visiting Professor Manchester University

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www.wrightington.com

Epidemiology

17.5% of all fractures

Average age 55 yrs

69% in Women

76% as a result of a fall, <1% open

OTA A 48% B 10% C 42%

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www.wrightington.com3


Guideline for treatment and prognosis?

Factors predictive of poor outcome

radial shortening >3mm

dorsal tilt > 12 degrees from normal

carpal malalignment

intra-articular incongruity

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What is the effect of radial shortening?

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Collaborators: Dr Isidro Arche, Prof Teresa Rasgado

What is the effect of dorsal tilt?


Collaborators: Dr Isidro Arche, Prof Teresa Rasgado


What is the effect of intra-articular step?


Personality of Fracture

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Axial Com

pression

Crush Shear

Tens

ion

Force Applied

Direction

Structure



B1

B3

B2

Majima. J Hand Surg 2008


Neutral Extension Neutral Extension

Majima J Hand Surg 2008



Relatively protected zones

Volar

Dorsal


Dorsal radioulnar

Radio scapho capitate

Long radiolunate

Short radiolunate

Palmar radioulnar

Dorsal radiocarpal


Dorsal radioulnar

Radio scapho capitate

Long radiolunate

Short radiolunate

Palmar radioulnar

Dorsal radiocarpal


JHS 2002





Die Punch injury







Always assess DRUJ stability









Associated Injuries

Scapholunate ligament injury 2 x more likely with intra-articular fractures only moderate inter-observer reliability for diagnosis from plain radiographs If there are no signs of SLD the risk of missing injury is 2%

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Chauffeur’s Fracture

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Arthroscopy and intra-articular distal radius fractures

Up to 68% will have ligamentous injury 43% TFCC lesion 32% SLIL lesion 15% LTIL lesion

Arthroscopic evaluation after ORIF will detect step >1mm in 33% Better reduction but no evidence for difference in PROM scores

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Edwards, Charles C., et al. "Intra-articular distal radius fractures: arthroscopic assessment of radiographically assisted reduction." The Journal of hand surgery 26.6 (2001): 1036-1041.

Geissler, William B., et al. "Intracarpal soft-tissue lesions associated with an intra-articular fracture of the distal end of the radius." J Bone Joint Surg Am 78.3 (1996): 357-65.

Ruch, David S., et al. "Arthroscopic reduction versus fluoroscopic reduction in the management of intra-articular distal radius fractures." Arthroscopy: The Journal of Arthroscopic & Related Surgery 20.3 (2004): 225-230.

Doi, Kazuteru, et al. "Intra-articular fractures of the distal aspect of the radius: arthroscopically assisted reduction compared with open reduction and internal fixation." J Bone Joint Surg Am 81.8 (1999): 1093-110.



Outcome

Minimum 5.5 years follow up 76% had radiographic signs OA

Significant association between residual displacement at union and arthrosis

However function independent of residual displacement and arthritis

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Intra-articular distal radius fractures

Rebalancing carpus will address most articular fragments

Attention to die punch injuries and volar ulnar fragments

Volar locking plates do not cure all!

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Intra-articular Dista Radius Fracture

Health & Medicine