Fracture assessment and decision making
These fractures are complete articular fractures of the distal radius.
As these are intraarticular fractures, where possible, they should be treated with anatomic reduction and absolute stability in order to minimize the risk of subsequent degenerative changes in the joint.
Anatomical reduction and stabilization of these articular fractures is also essential because of the functional implications of the involvement of the distal radioulnar joint.
These are among the most common fractures seen and treated in the older population, with underlying osteoporosis. When these fractures occur in younger individuals, they are more likely to be the result of high energy trauma, with associated soft-tissue, or skeletal injuries. It is not possible to make an accurate assessment of the details of these injuries without a CT scan.
Plate fixation may be applicable for all complete articular fractures, provided the distal fragments are large enough to be held with screws. As long as the articular surface is accurately reduced, and is fixed in the correct position in relation to the radial shaft, it is not necessary to fix all the metaphyseal fragments and the plate may be used in a bridging mode.