Basic treatment techniques |
Basic technique: Modular external fixation |
Extraarticular fracture of the ulnar styloid processPlease select a treatment option: |
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Treatment | Main indication | Skill | Equipment |
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Nonoperative treatment - Cast | Stable wrist and DRU joint | ![]() |
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ORIF - Tension band wire | Unstable, small fragment | ![]() |
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ORIF - Lag screw | Unstable, large fragment | ![]() |
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Extraarticular simple fracture of the ulnaPlease select a treatment option: |
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Treatment | Main indication | Skill | Equipment |
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Nonoperative treatment - Cast | Stable, undisplaced: reducible, transverse fracture | ![]() |
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ORIF - Lag screw and protection plate | Unstable fracture | ![]() |
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ORIF - Compression plate | Transverse, or short oblique fracture | ![]() |
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Extraarticular multifragmentary fracture of the ulnaPlease select a treatment option: |
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Treatment | Main indication | Skill | Equipment |
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Nonoperative treatment - Cast | Unfit or low-demand patient | ![]() |
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ORIF - Bridge plate | All ulnar multifragmentary extraarticular fractures, where possible | ![]() |
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ORIF - Hook plate | All ulnar multifragmentary extraarticular fractures, where possible | ![]() |
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Extraarticular undisplaced fracture of the radiusPlease select a treatment option: |
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Treatment | Main indication | Skill | Equipment |
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Nonoperative treatment - Cast | Almost all radial extraarticular simple fractures with no displacement/tilt | ![]() |
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Joint-spanning external fixation (temporary or definitive) | Temporary stabilization in polytrauma, unfit patient, insufficient hold in a cast, patient not suitable for ORIF | ![]() |
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ORIF - Palmar plate | Severe shortening, late collapse, associated neurovascular injury | ![]() |
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Extraarticular fracture of the radius with dorsal displacement or tiltPlease select a treatment option: |
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Treatment | Main indication | Skill | Equipment |
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Nonoperative treatment - Cast | Reducible fracture in absence of dorsal comminution | ![]() |
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Joint-spanning external fixation (temporary or definitive) | Temporary stabilization in polytrauma, unfit patient, insufficient hold in a cast, patient not suitable for ORIF | ![]() |
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Closed reduction - K-wires and cast/external fixator | Unstable fractures, loss of reduction | ![]() |
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ORIF - Palmar plate | Unstable fracture, dorsal comminution, associated neurovascular injury | ![]() |
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Extraarticular fracture of the radius with volar displacement or tiltPlease select a treatment option: |
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Treatment | Main indication | Skill | Equipment |
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Nonoperative treatment - Cast | Reducible fracture in absence of palmar comminution | ![]() |
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Joint-spanning external fixation (temporary or definitive) | Temporary stabilization in polytrauma, unfit patient, insufficient hold in a cast, patient not suitable for ORIF | ![]() |
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Closed reduction - K-wires and cast/external fixator | Unstable fractures, loss of reduction | ![]() |
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ORIF - Palmar plate | Irreducible, or unstable reduction, associated neurovascular injury | ![]() |
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Extraarticular wedge or multifragmentary fracture of the radiusPlease select a treatment option: |
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Treatment | Main indication | Skill | Equipment |
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Nonoperative treatment - Cast | Low-demand patient; surgery not possible | ![]() |
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Joint-spanning external fixation (temporary or definitive) | Temporary stabilization in polytrauma, unfit patient, insufficient hold in a cast, patient not suitable for ORIF | ![]() |
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Closed reduction - K-wires and cast/external fixator | Unstable fractures, loss of reduction | ![]() |
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ORIF - Palmar bridge plate | Irreducible, or unstable reduction: associated neurovascular injury | ![]() |
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Partial articular, sagittal simple radial fracture, involving scaphoid fossaPlease select a treatment option: |
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Treatment | Main indication | Skill | Equipment |
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Nonoperative treatment - Cast | Minimally displaced fracture, low demand patient | ![]() |
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Joint-spanning external fixation (temporary or definitive) | Temporary stabilization in polytrauma, unfit patient, insufficient hold in a cast, patient not suitable for ORIF | ![]() |
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Closed reduction - K-wires and cast/external fixator | Unstable fractures, loss of reduction | ![]() |
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Closed reduction - Lag screws | Displaced, reducible, no intercarpal ligament instability | ![]() |
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ORIF - Palmar plate | Failed, or unstable reduction | ![]() |
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ORIF - Radial column plate | Failed, or unstable reduction | ![]() |
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Partial articular, sagittal multifragmentary radial fracture, involving scaphoid fossaPlease select a treatment option: |
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Treatment | Main indication | Skill | Equipment |
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Nonoperative treatment - Cast | Minimally displaced fracture, low-demand patient | ![]() |
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Joint-spanning external fixation (temporary or definitive) | Temporary stabilization in polytrauma, unfit patient, insufficient hold in a cast, patient not suitable for ORIF | ![]() |
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ORIF - Lag screws/K-wires | Displaced, irreducible | ![]() |
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ORIF - Radial column plate | Failed, or unstable reduction | ![]() |
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Partial articular, sagittal fracture of the radius, involving the lunate fossaPlease select a treatment option: |
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Treatment | Main indication | Skill | Equipment |
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Nonoperative treatment - Cast | Minimally displaced: low-demand patient | ![]() |
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Joint-spanning external fixation (temporary or definitive) | Temporary stabilization in polytrauma, unfit patient, insufficient hold in a cast, patient not suitable for ORIF | ![]() |
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ORIF - Dorsal plate | Failed or unstable articular reduction | ![]() |
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Partial articular, simple fracture of the radius, involving the dorsal rimPlease select a treatment option: |
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Treatment | Main indication | Skill | Equipment |
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Nonoperative treatment - Cast | Low-demand patient | ![]() |
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Joint-spanning external fixation (temporary or definitive) | Temporary stabilization in polytrauma, unfit patient, insufficient hold in a cast, patient not suitable for ORIF | ![]() |
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ORIF - Dorsal plate | Almost all radial partial articular, dorsal rim, simple fractures | ![]() |
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Partial articular, fragmentary fracture of the radius, involving dorsal rimPlease select a treatment option: |
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Treatment | Main indication | Skill | Equipment |
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Nonoperative treatment - Cast | Patient not fit for surgery, low demand patient | ![]() |
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Joint-spanning external fixation (temporary or definitive) | Temporary stabilization in polytrauma, unfit patient, insufficient hold in a cast, patient not suitable for ORIF | ![]() |
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ORIF - Dorsoradial double plate | Almost all radial dorsal rim fractures, involving the scaphoid fossa | ![]() |
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Partial articular fracture of the radius, with dorsal dislocationPlease select a treatment option: |
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Treatment | Main indication | Skill | Equipment |
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Nonoperative treatment - Cast | Patient not fit for surgery, low demand patient | ![]() |
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Joint-spanning external fixation (temporary or definitive) | Temporary stabilization in polytrauma, unfit patient, insufficient hold in a cast, patient not suitable for ORIF | ![]() |
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ORIF - Dorsoradial double plate | Almost all partial articular fractures which involve a significant radial styloid fragment. | ![]() |
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ORIF - Dorsal double plate | Almost all partial articular fractures which involve a significant radial styloid fragment | ![]() |
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Partial articular fracture of the radius, involving the volar rimPlease select a treatment option: |
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Treatment | Main indication | Skill | Equipment |
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Nonoperative treatment - Cast | Low-demand patient; surgery contraindicated | ![]() |
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Joint-spanning external fixation (temporary) | Temporary stabilization in polytrauma, unfit patient, insufficient hold in a cast, patient not suitable for ORIF | ![]() |
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ORIF - Palmar plate | Almost all Goyrand-Smith II fractures | ![]() |
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Complete simple articular, simple metaphyseal radial fracturePlease select a treatment option: |
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Treatment | Main indication | Skill | Equipment |
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Nonoperative treatment - Cast | Unfit or low-demand patient, undisplaced fracture | ![]() |
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Joint-spanning external fixation (temporary or definitive) | Temporary stabilization in polytrauma, unfit patient, insufficient hold in a cast, patient not suitable for ORIF | ![]() |
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Closed reduction - K-wires and cast/external fixator | Reducible and large fragments, low demand patients | ![]() |
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ORIF - Palmar plate | Almost all complete articular simple fractures of the radius | ![]() |
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ORIF - Dorsoradial double plate | When a posterior approach is necessary to treat intercarpal instability | ![]() |
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Complete simple articular, fragmented metaphysis radial fracturePlease select a treatment option: |
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Treatment | Main indication | Skill | Equipment |
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Nonoperative treatment - Cast | Unfit or low-demand patient, undisplaced fracture | ![]() |
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Joint-spanning external fixation (temporary or definitive) | Temporary stabilization in polytrauma, unfit patient, insufficient hold in a cast, patient not suitable for ORIF | ![]() |
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Closed reduction - K-wires and cast/external fixator | Reducible and large fragments, low demand patients | ![]() |
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ORIF - Palmar bridge plate | Most complete articular fractures with marked metaphyseal comminution | ![]() |
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ORIF - Dorsoradial double plate | When a dorsal approach is necessary to treat intercarpal instability | ![]() |
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Complete multifragmentary fracture of the radiusPlease select a treatment option: |
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Treatment | Main indication | Skill | Equipment |
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Nonoperative treatment - Cast | Unfit or low-demand patient, undisplaced fracture | ![]() |
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Joint-spanning external fixation (temporary or definitive) | Temporary stabilization in polytrauma, unfit patient, insufficient hold in a cast, patient not suitable for ORIF | ![]() |
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ORIF - Palmar bridge plate | Marked metaphyseal comminution | ![]() |
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ORIF - Joint-spanning distraction plate | Severe comminution | ![]() |
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ORIF - Dorsoradial double plate | When a posterior approach is necessary to treat intercarpal instability | ![]() |
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ORIF - Dorsoradiopalmar triple plate | Gross articular injury which can be reconstructed | ![]() |
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Special considerations |
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Principles of management of open fractures | |||
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*Skill | |
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Basic surgical experience, no specialized skills |
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Some specialized surgical experience |
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Highly experienced and skilled surgeon |
*Equipment | |
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Basic equipment only |
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Simple surgical and imaging resources |
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Full specialized surgical and imaging resources |