intra-articular dista radius fracture
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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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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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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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Collaborators: Dr Isidro Arche, Prof Teresa Rasgado
What is the effect of dorsal tilt?
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Personality of Fracture
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Axial Com
pression
Crush Shear
Tens
ion
Force Applied
Direction
Structure
Majima. J Hand Surg 2008
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Neutral Extension Neutral Extension
Majima J Hand Surg 2008
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Dorsal radioulnar
Radio scapho capitate
Long radiolunate
Short radiolunate
Palmar radioulnar
Dorsal radiocarpal
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Dorsal radioulnar
Radio scapho capitate
Long radiolunate
Short radiolunate
Palmar radioulnar
Dorsal radiocarpal
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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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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.
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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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