5.1 Introduction

Distal radius fractures are common fractures seen in the emergency department and occur in a bimodal distribution, affecting young males following high-energy trauma, and the elderly after low-energy falls. In the 1800s, Dr Colles and Dr Dupuytren believed distal radius fractures had good outcomes irrespective of treatment. However, since this time it has been repeatedly shown that the reconstruction of the distal radius articular anatomy is linked to a return of function. Over this time, there have been various treatment options, including but not limited to external fixation, percutaneous fixation with Kirschner wires, dorsal plating, volar plating, internal bracing with a plate (bridge plate), etc. Fracture management is guided by injury type, age, activity level, and other injuries.

5.2 Indications

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  Extra-articular metaphyseal fractures with radial shortening >5 mm and dorsal tilt >10 degrees from neutral

  
  
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  Volar shear fractures (▶Fig. 5.1)

  
  
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  Irreducible intra-articular fractures with greater than >2 mm articular step-off

  
  
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  Any distal radius fracture with signs and symptoms of acute carpal tunnel or compartment syndrome after attempted reduction ^{1 , 2}

5.3 Contraindications

Severely contaminated open injuries or skeletally immature patients

5.4 Patient Positioning

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  Supine position with the volar forearm exposed on an arm board

  
  
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  Make sure contralateral upper extremity and lower extremities are protected at potential areas of nerve compression.

  
  
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  A properly sized tourniquet should be placed on the arm above the level of the elbow.