Arvind D. Nana, MD, Atul Joshi, MD, and David M. Lichtman, MD
Distal radius fractures are common injuries that can be treated by a variety of methods. Restoration of the distal radius anatomy within established guidelines yields the best short- and long-term results. Guidelines for acceptable reduction are (1) radial shortening 5 mm, (2) radial inclination 15°, (3) sagittal tilt on lateral projection between 15° dorsal tilt and 20° volar tilt, (4) intra-articular step-off 2 mm of the radiocarpal joint, and (5) articular incongruity 2 mm of the sigmoid notch of the distal radius. Treatment options range from closed reduction and immobilization to open reduction with plates and screws; options are differentiated based on their ability to reinforce and stabilize the three columns of the distal radius and ulna. Plating allows direct restoration of the anatomy, stable internal fixation, a decreased period of immobilization, and early return of wrist function. Buttress plates reduce and stabilize vertical shear intra-articular fractures through an antiglide effect, whereas conventional and locking plates address metaphyseal comminution and/or preserve articular congruity/reduction. With conventional and locking plates, intra-articular fractures are directly reduced; with buttress plates, the plate itself helps reduce the intra-articular fracture. Complications associated with plating include tendon irritation or rupture and the need for plate removal.
Journal of American Academy or Orthopaedic Surgerons. May/June 2005 Article Abstracts-