Distal forearm

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Basic treatment techniques
Basic technique: Modular external fixation

Extraarticular fracture of the ulnar styloid process Please select a treatment option:
Treatment	Main indication	Skill	Equipment
Nonoperative treatment - Cast	Stable wrist and DRU joint
ORIF - Tension band wire	Unstable, small fragment
ORIF - Lag screw	Unstable, large fragment

Extraarticular simple fracture of the ulna Please select a treatment option:
Treatment	Main indication	Skill	Equipment
Nonoperative treatment - Cast	Stable, undisplaced: reducible, transverse fracture
ORIF - Lag screw and protection plate	Unstable fracture
ORIF - Compression plate	Transverse, or short oblique fracture

Extraarticular multifragmentary fracture of the ulna Please select a treatment option:
Treatment	Main indication	Skill	Equipment
Nonoperative treatment - Cast	Unfit or low-demand patient
ORIF - Bridge plate	All ulnar multifragmentary extraarticular fractures, where possible
ORIF - Hook plate	All ulnar multifragmentary extraarticular fractures, where possible

Extraarticular undisplaced fracture of the radius Please select a treatment option:
Treatment	Main indication	Skill	Equipment
Nonoperative treatment - Cast	Almost all radial extraarticular simple fractures with no displacement/tilt
Joint-spanning external fixation (temporary or definitive)	Temporary stabilization in polytrauma, unfit patient, insufficient hold in a cast, patient not suitable for ORIF
ORIF - Palmar plate	Severe shortening, late collapse, associated neurovascular injury

Extraarticular fracture of the radius with dorsal displacement or tilt Please select a treatment option:
Treatment	Main indication	Skill	Equipment
Nonoperative treatment - Cast	Reducible fracture in absence of dorsal comminution
Joint-spanning external fixation (temporary or definitive)	Temporary stabilization in polytrauma, unfit patient, insufficient hold in a cast, patient not suitable for ORIF
Closed reduction - K-wires and cast/external fixator	Unstable fractures, loss of reduction
ORIF - Palmar plate	Unstable fracture, dorsal comminution, associated neurovascular injury

Extraarticular fracture of the radius with volar displacement or tilt Please select a treatment option:
Treatment	Main indication	Skill	Equipment
Nonoperative treatment - Cast	Reducible fracture in absence of palmar comminution
Joint-spanning external fixation (temporary or definitive)	Temporary stabilization in polytrauma, unfit patient, insufficient hold in a cast, patient not suitable for ORIF
Closed reduction - K-wires and cast/external fixator	Unstable fractures, loss of reduction
ORIF - Palmar plate	Irreducible, or unstable reduction, associated neurovascular injury

Extraarticular wedge or multifragmentary fracture of the radius Please select a treatment option:
Treatment	Main indication	Skill	Equipment
Nonoperative treatment - Cast	Low-demand patient; surgery not possible
Joint-spanning external fixation (temporary or definitive)	Temporary stabilization in polytrauma, unfit patient, insufficient hold in a cast, patient not suitable for ORIF
Closed reduction - K-wires and cast/external fixator	Unstable fractures, loss of reduction
ORIF - Palmar bridge plate	Irreducible, or unstable reduction: associated neurovascular injury

Partial articular, sagittal simple radial fracture, involving scaphoid fossa Please select a treatment option:
Treatment	Main indication	Skill	Equipment
Nonoperative treatment - Cast	Minimally displaced fracture, low demand patient
Joint-spanning external fixation (temporary or definitive)	Temporary stabilization in polytrauma, unfit patient, insufficient hold in a cast, patient not suitable for ORIF
Closed reduction - K-wires and cast/external fixator	Unstable fractures, loss of reduction
Closed reduction - Lag screws	Displaced, reducible, no intercarpal ligament instability
ORIF - Palmar plate	Failed, or unstable reduction
ORIF - Radial column plate	Failed, or unstable reduction

Partial articular, sagittal multifragmentary radial fracture, involving scaphoid fossa Please select a treatment option:
Treatment	Main indication	Skill	Equipment
Nonoperative treatment - Cast	Minimally displaced fracture, low-demand patient
Joint-spanning external fixation (temporary or definitive)	Temporary stabilization in polytrauma, unfit patient, insufficient hold in a cast, patient not suitable for ORIF
ORIF - Lag screws/K-wires	Displaced, irreducible
ORIF - Radial column plate	Failed, or unstable reduction

Partial articular, sagittal fracture of the radius, involving the lunate fossa Please select a treatment option:
Treatment	Main indication	Skill	Equipment
Nonoperative treatment - Cast	Minimally displaced: low-demand patient
Joint-spanning external fixation (temporary or definitive)	Temporary stabilization in polytrauma, unfit patient, insufficient hold in a cast, patient not suitable for ORIF
ORIF - Dorsal plate	Failed or unstable articular reduction

Partial articular, simple fracture of the radius, involving the dorsal rim Please select a treatment option:
Treatment	Main indication	Skill	Equipment
Nonoperative treatment - Cast	Low-demand patient
Joint-spanning external fixation (temporary or definitive)	Temporary stabilization in polytrauma, unfit patient, insufficient hold in a cast, patient not suitable for ORIF
ORIF - Dorsal plate	Almost all radial partial articular, dorsal rim, simple fractures

Partial articular, fragmentary fracture of the radius, involving dorsal rim Please select a treatment option:
Treatment	Main indication	Skill	Equipment
Nonoperative treatment - Cast	Patient not fit for surgery, low demand patient
Joint-spanning external fixation (temporary or definitive)	Temporary stabilization in polytrauma, unfit patient, insufficient hold in a cast, patient not suitable for ORIF
ORIF - Dorsoradial double plate	Almost all radial dorsal rim fractures, involving the scaphoid fossa

Partial articular fracture of the radius, with dorsal dislocation Please select a treatment option:
Treatment	Main indication	Skill	Equipment
Nonoperative treatment - Cast	Patient not fit for surgery, low demand patient
Joint-spanning external fixation (temporary or definitive)	Temporary stabilization in polytrauma, unfit patient, insufficient hold in a cast, patient not suitable for ORIF
ORIF - Dorsoradial double plate	Almost all partial articular fractures which involve a significant radial styloid fragment.
ORIF - Dorsal double plate	Almost all partial articular fractures which involve a significant radial styloid fragment

Partial articular fracture of the radius, involving the volar rim Please select a treatment option:
Treatment	Main indication	Skill	Equipment
Nonoperative treatment - Cast	Low-demand patient; surgery contraindicated
Joint-spanning external fixation (temporary)	Temporary stabilization in polytrauma, unfit patient, insufficient hold in a cast, patient not suitable for ORIF
ORIF - Palmar plate	Almost all Goyrand-Smith II fractures

Complete simple articular, simple metaphyseal radial fracture Please select a treatment option:
Treatment	Main indication	Skill	Equipment
Nonoperative treatment - Cast	Unfit or low-demand patient, undisplaced fracture
Joint-spanning external fixation (temporary or definitive)	Temporary stabilization in polytrauma, unfit patient, insufficient hold in a cast, patient not suitable for ORIF
Closed reduction - K-wires and cast/external fixator	Reducible and large fragments, low demand patients
ORIF - Palmar plate	Almost all complete articular simple fractures of the radius
ORIF - Dorsoradial double plate	When a posterior approach is necessary to treat intercarpal instability

Complete simple articular, fragmented metaphysis radial fracture Please select a treatment option:
Treatment	Main indication	Skill	Equipment
Nonoperative treatment - Cast	Unfit or low-demand patient, undisplaced fracture
Joint-spanning external fixation (temporary or definitive)	Temporary stabilization in polytrauma, unfit patient, insufficient hold in a cast, patient not suitable for ORIF
Closed reduction - K-wires and cast/external fixator	Reducible and large fragments, low demand patients
ORIF - Palmar bridge plate	Most complete articular fractures with marked metaphyseal comminution
ORIF - Dorsoradial double plate	When a dorsal approach is necessary to treat intercarpal instability

Complete multifragmentary fracture of the radius Please select a treatment option:
Treatment	Main indication	Skill	Equipment
Nonoperative treatment - Cast	Unfit or low-demand patient, undisplaced fracture
Joint-spanning external fixation (temporary or definitive)	Temporary stabilization in polytrauma, unfit patient, insufficient hold in a cast, patient not suitable for ORIF
ORIF - Palmar bridge plate	Marked metaphyseal comminution
ORIF - Joint-spanning distraction plate	Severe comminution
ORIF - Dorsoradial double plate	When a posterior approach is necessary to treat intercarpal instability
ORIF - Dorsoradiopalmar triple plate	Gross articular injury which can be reconstructed

Special considerations
Principles of management of open fractures
Complications Infection Compartment syndrome

*Skill
	Basic surgical experience, no specialized skills
	Some specialized surgical experience
	Highly experienced and skilled surgeon

*Equipment
	Basic equipment only
	Simple surgical and imaging resources
	Full specialized surgical and imaging resources

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