Summary & Conclusion

77

Summary
Distal radius fractures are the most frequent lesions encountered
during clinical practice. The treatment is controversial and still debated in
the literature.
[1]
The distal end of the radius forms the anatomic foundation of the
wrist joint.
[13]
The volar surface of the distal radius is relatively flat. It is
covered proximally by the pronator quadratus muscle. The flexor tendons
and the median nerve lay more superficially. The dorsal surface is
convex.
[14]
The wrist complex is biaxial joint, with motions of
flexion/extension (volar flexion/dorsiflexion) around a coronal axis, and
radial deviation/ ulnar deviation (abduction/adduction) around an
anteroposterior axis.
[29]
Most commonly, injuries occur after a simple fall from standing
height. Almost all distal radius fractures (apart from dorsal rim avulsion
fractures) can be produced by hyperextension of the wrist.

Bending forces
tend to occur in low-energy falls and typically produce dorsal
displacement. Shearing forces disrupt the ligamentous connections of the
wrist and produce unstable fracture-dislocations, whilst axial loading,
high-energy injuries compress the articular surface and cause fragments
of joint surface to be impacted.
[51, 52]
Various classification systems have been proposed to describe the
injury and help formulate a treatment plan. Broadly they tend to be
anatomical classifications that group fracture patterns, biomechanical that
describe the mechanism of injury and fracture stability or a combination
of both.
[51]

Summary & Conclusion

78

Locking plates have revolutionised treatment for distal radius
fractures. However, proper reduction and technique remain as important
as ever.
[71]
The advent of fixed-angle locking plates has improved fracture
healing and addressed the inadequacies of nonlocked plates. Formerly, a
rigid fixation construct with a nonlocked plate was achieved only if there
was minimal motion at the joint or if the bone density was sufficient to
withstand applied physiologic load. In other words, the stability of the
screws in the bone and at the screwplate interface was possible if the
load was kept to a minimum. These are limiting factors that require
prolonged cast immobilization even after surgical fixation. In
osteoporotic bone, minimal axial stress may permit toggling of the screws
and become loose. The locking plate introduced tines at the screw plate
interface creating a single beam construct, which has been reported to
be four times stronger than constructs that allow motion between the
screws and plate.
[44]
Conclusion:
Locked plate is ideal for distal radius fractures.
It decreases the potential for toggling of the screws in the cortex.
It permits early range of motion postoperatively, as the construct
can withstand physiologic loading.

Allows the volar approach to be used to treat both volar and dorsal
displaced fractures.
Special value in the management of highly comminuted
metaphyseal and/or osteoporotic fractures in which screws
purchase in the distal fragments might be impossible.