Distal Radius Fractures

With the wide array of treatment options now available, this is an exciting era for the treatment of fractures of the distal radius. An improved understanding of kinematics, bone quality, and muscle forces acting across the fracture has led to increased awareness of a fracture’s relative stability, as well as the development of innovative devices to counteract these forces and restore stability. Innovations have occurred in closed treatment, percutaneous fixation, external fixation, and in particular, implants for internal fixation. However, new devices and techniques require careful assessment of efficacy, risk, and benefit as they are applied in practice, especially since the incidence of this fracture is likely to rise in an aging population. At this time, there are few published studies that definitively demonstrate the superiority of one technique or implant over another, as long as the anatomy of the distal radius is restored. Distal radius fractures are the most common fractures seen in the emergency department; they represent approximately 3% of all upper extremity injuries, with an incidence of greater than 640,000 annually in the United States alone. There is a bimodal distribution of these injuries, with a peak in the 5to 24-year-old, predominantly male population who sustain athletic and high-energy injuries and a second peak in the elderly, predominantly female population characterized by lower-energy or “fragility” fractures. U.S. census data indicate that the percentage of persons aged 65 and older in the United States will rise from 12% to 19% over the next quarter century. Osteoporosis may be contributing to fractures in the elderly, and therefore improved attention to care of this condition may reduce the incidence of such fractures. The goals of this chapter are to provide the surgeon with a detailed understanding of fracture types, better knowledge of wrist and fracture mechanics, improved recognition of individual fracture fragments in complex fractures, and an understanding of expectations of fracture treatment. Using a case-based approach, it is hoped that the reader will have a better appreciation of the factors influencing the results of treatment and enable the surgeon to develop an effective approach to this injury.