Bridge Plating of Distal Radius Fractures



Bridge Plating of Distal Radius Fractures


Paul A. Martineau

Kevin J. Malone

Douglas P. Hanel





ANATOMY



  • The articular surface of the distal radius is tilted 21 degrees in the anteroposterior plane and 5 to 11 degrees in the lateral plane.


  • The dorsal cortex surface of the radius thickens to form the tubercle of Lister.


  • A central ridge divides the articular surface of the radius into a scaphoid facet and a lunate facet.


  • Because of the different areas of bone thickness and density, fractures tend to occur in the relatively weaker metaphyseal bone and propagate intra-articularly between the scaphoid and lunate facets.


  • The degree, direction, and magnitude of applied load may cause coronal or sagittal splits within the lunate or scaphoid facets.


PATHOGENESIS



  • Two subsets of patients with distal radius fractures continue to represent unique treatment challenges:



    • Patients with high-energy wrist injuries with fracture extension into the radial diaphysis


    • Patients with multiple injuries who require load bearing through the injured wrist to assist with mobilization and nursing care


NATURAL HISTORY



  • Lafontaine et al13 showed that the end results of comminuted distal radius fractures treated by closed methods resembled the prereduction radiographs more than any other radiographs during treatment, even when the reduction successfully restored wrist anatomy.


  • A number of studies clearly show that restoration of normal anatomy after distal radius fracture provides better function.4,6,7,8,10,11,12,14


  • Functional outcome scores in patients without anatomic reduction are poor.4,15


  • Malunion of the distal radius has been associated with pain, stiffness, weak grip strength, and carpal instability in a substantial percentage of patients.8 Long-term consequences include degenerative arthritis in up to 50% of patients with even minimal displacement in the young adult population.16


  • As surgical treatment (plating in particular) ensures more consistent correction of displacement and maintenance of reduction, there has been a trend toward operative treatment in both the elderly and the young population.


PATIENT HISTORY AND PHYSICAL FINDINGS



  • In the management of high-energy distal radius fractures, a complete history should include the mechanism of injury. These fractures are commonly the result of axial loading as opposed to the bending forces, which are all low-velocity fractures.


  • Examination of the soft tissue envelope of the wrist should be performed to rule out open fractures.


  • Because of the high-energy nature of these fractures, patients are at increased risk of neurovascular compromise. Careful examination for signs of impending compartment syndrome as well as median nerve dysfunction from an acute carpal tunnel syndrome should be clearly documented.


  • Associated injuries should be ruled out, and appropriate patient clearance according to advanced trauma life support guidelines should be obtained.


IMAGING AND OTHER DIAGNOSTIC STUDIES



  • Good-quality pre- and postreduction wrist radiographs should be obtained preoperatively to assess the fracture pattern and rule out associated injuries to the carpus or distal radioulnar joint (DRUJ).


  • Computed tomography (CT) scans may be helpful to assess complex intra-articular distal radius fractures.


NONOPERATIVE MANAGEMENT



  • There is no acceptable nonoperative management for high-energy comminuted distal radius fractures.


SURGICAL MANAGEMENT

Jul 22, 2016 | Posted by in ORTHOPEDIC | Comments Off on Bridge Plating of Distal Radius Fractures
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