Distal radius fractures and wrist dislocations

Distal radius fractures are extremely common in both the paediatric and adult population.  Usually paediatric fractures occur through the growth plate and may be managed by a closed reduction and well moulded cast to keep the fracture reduced and held while it heals.

In adult distal radius fractures, there are two “groups” of fractures. The younger population with good bone stock that have a high energy injury and sustain a fracture, and the older patient with osteoporosis or poor bone stock that sustain a simple fall and fracture their wrists. Regardless of mechanism, there is up to a 60% incidence of associated injury to the TFCC on the ulnar side of the wrist, and about a 20% incidence of both carpal bone fractures and scapholunate ligament injuries. These injuries are not benign.

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  • Management

Many distal radius fractures may be appropriately treated in a cast for 6 weeks, and recover well from the injury. However operative management is recommended in significantly displaced fractures, fractures with concomitant injuries requiring surgery, open injuries, and fractures that leave an unacceptable step in the joint.

The principle of operative management is to accurately dissect between the muscles, tendons, nerves and vessels, gently reorient the displaced fragments and apply a plate and screws to hold it in place while it heals. Certain fractures in the joint are more accurately reduced under direct vision using wrist arthroscopy, and this may be used in select cases.

Postoperatively it is important to keep the hand elevated to reduce swelling and get the fingers moving as soon as possible, in order for the tendons to retain their glide.

Depending on the bone stock and the fixation, early range of motion with flexion and extension movement at the wrist, and critically rotation of the wrist is important, as the ability to turn the hand upwards is most predicative of a happy postoperative outcome.

Conditions Managed

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