Distal forearm - Reduction & Fixation

Basic treatment techniques

Basic technique: Modular external fixation

Extraarticular fracture of the ulnar styloid process

Nonoperative treatment - Cast

Main indication: Stable wrist and DRU joint

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ORIF - Tension band wire

Main indication: Unstable, small fragment

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ORIF - Lag screw

Main indication: Unstable, large fragment

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Extraarticular simple fracture of the ulna

Nonoperative treatment - Cast

Main indication: Stable, undisplaced: reducible, transverse fracture

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ORIF - Lag screw and protection plate

Main indication: Unstable fracture

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ORIF - Compression plate

Main indication: Transverse, or short oblique fracture

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Extraarticular multifragmentary fracture of the ulna

Nonoperative treatment - Cast

Main indication: Unfit or low-demand patient

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ORIF - Bridge plate

Main indication: All ulnar multifragmentary extraarticular fractures, where possible

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ORIF - Hook plate

Main indication: All ulnar multifragmentary extraarticular fractures, where possible

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Extraarticular undisplaced fracture of the radius

Nonoperative treatment - Cast

Main indication: Almost all radial extraarticular simple fractures with no displacement/tilt

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Joint-spanning external fixation (temporary or definitive)

Main indication: Temporary stabilization in polytrauma, unfit patient, insufficient hold in a cast, patient not suitable for ORIF

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ORIF - Palmar plate

Main indication: Severe shortening, late collapse, associated neurovascular injury

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Extraarticular fracture of the radius with dorsal displacement or tilt

Nonoperative treatment - Cast

Main indication: Reducible fracture in absence of dorsal comminution

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Joint-spanning external fixation (temporary or definitive)

Main indication: 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

Main indication: Unstable fractures, loss of reduction

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ORIF - Palmar plate

Main indication: Unstable fracture, dorsal comminution, associated neurovascular injury

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Extraarticular fracture of the radius with volar displacement or tilt

Nonoperative treatment - Cast

Main indication: Reducible fracture in absence of palmar comminution

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Joint-spanning external fixation (temporary or definitive)

Main indication: 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

Main indication: Unstable fractures, loss of reduction

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ORIF - Palmar plate

Main indication: Irreducible, or unstable reduction, associated neurovascular injury

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Extraarticular wedge or multifragmentary fracture of the radius

Nonoperative treatment - Cast

Main indication: Low-demand patient; surgery not possible

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Joint-spanning external fixation (temporary or definitive)

Main indication: 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

Main indication: Unstable fractures, loss of reduction

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ORIF - Palmar bridge plate

Main indication: Irreducible, or unstable reduction: associated neurovascular injury

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Partial articular, sagittal simple radial fracture, involving scaphoid fossa

Nonoperative treatment - Cast

Main indication: Minimally displaced fracture, low demand patient

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Joint-spanning external fixation (temporary or definitive)

Main indication: 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

Main indication: Unstable fractures, loss of reduction

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Closed reduction - Lag screws

Main indication: Displaced, reducible, no intercarpal ligament instability

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ORIF - Palmar plate

Main indication: Failed, or unstable reduction

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ORIF - Radial column plate

Main indication: Failed, or unstable reduction

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Partial articular, sagittal multifragmentary radial fracture, involving scaphoid fossa

Nonoperative treatment - Cast

Main indication: Minimally displaced fracture, low-demand patient

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Joint-spanning external fixation (temporary or definitive)

Main indication: 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

Main indication: Displaced, irreducible

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ORIF - Radial column plate

Main indication: Failed, or unstable reduction

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Partial articular, sagittal fracture of the radius, involving the lunate fossa

Nonoperative treatment - Cast

Main indication: Minimally displaced: low-demand patient

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Joint-spanning external fixation (temporary or definitive)

Main indication: Temporary stabilization in polytrauma, unfit patient, insufficient hold in a cast, patient not suitable for ORIF

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ORIF - Dorsal plate

Main indication: Failed or unstable articular reduction

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Partial articular, simple fracture of the radius, involving the dorsal rim

Nonoperative treatment - Cast

Main indication: Low-demand patient

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Joint-spanning external fixation (temporary or definitive)

Main indication: Temporary stabilization in polytrauma, unfit patient, insufficient hold in a cast, patient not suitable for ORIF

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ORIF - Dorsal plate

Main indication: Almost all radial partial articular, dorsal rim, simple fractures

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Partial articular, fragmentary fracture of the radius, involving dorsal rim

Nonoperative treatment - Cast

Main indication: Patient not fit for surgery, low demand patient

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Joint-spanning external fixation (temporary or definitive)

Main indication: Temporary stabilization in polytrauma, unfit patient, insufficient hold in a cast, patient not suitable for ORIF

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ORIF - Dorsoradial double plate

Main indication: Almost all radial dorsal rim fractures, involving the scaphoid fossa

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Partial articular fracture of the radius, with dorsal dislocation

Nonoperative treatment - Cast

Main indication: Patient not fit for surgery, low demand patient

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Joint-spanning external fixation (temporary or definitive)

Main indication: Temporary stabilization in polytrauma, unfit patient, insufficient hold in a cast, patient not suitable for ORIF

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ORIF - Dorsoradial double plate

Main indication: Almost all partial articular fractures which involve a significant radial styloid fragment.

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ORIF - Dorsal double plate

Main indication: 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 rim

Nonoperative treatment - Cast

Main indication: Low-demand patient; surgery contraindicated

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Joint-spanning external fixation (temporary)

Main indication: Temporary stabilization in polytrauma, unfit patient, insufficient hold in a cast, patient not suitable for ORIF

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ORIF - Palmar plate

Main indication: Almost all Goyrand-Smith II fractures

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Complete simple articular, simple metaphyseal radial fracture

Nonoperative treatment - Cast

Main indication: Unfit or low-demand patient, undisplaced fracture

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Joint-spanning external fixation (temporary or definitive)

Main indication: 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

Main indication: Reducible and large fragments, low demand patients

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ORIF - Palmar plate

Main indication: Almost all complete articular simple fractures of the radius

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ORIF - Dorsoradial double plate

Main indication: When a posterior approach is necessary to treat intercarpal instability

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Complete simple articular, fragmented metaphysis radial fracture

Nonoperative treatment - Cast

Main indication: Unfit or low-demand patient, undisplaced fracture

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Joint-spanning external fixation (temporary or definitive)

Main indication: Temporary stabilization in polytrauma, unfit patient, insufficient hold in a cast, patient not suitable for ORIF

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Equipment:

Closed reduction - K-wires and cast/external fixator

Main indication: Reducible and large fragments, low demand patients

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ORIF - Palmar bridge plate

Main indication: Most complete articular fractures with marked metaphyseal comminution

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ORIF - Dorsoradial double plate

Main indication: When a dorsal approach is necessary to treat intercarpal instability

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Complete multifragmentary fracture of the radius

Nonoperative treatment - Cast

Main indication: Unfit or low-demand patient, undisplaced fracture

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Equipment:

Joint-spanning external fixation (temporary or definitive)

Main indication: Temporary stabilization in polytrauma, unfit patient, insufficient hold in a cast, patient not suitable for ORIF

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ORIF - Palmar bridge plate

Main indication: Marked metaphyseal comminution

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ORIF - Joint-spanning distraction plate

Main indication: Severe comminution

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ORIF - Dorsoradial double plate

Main indication: When a posterior approach is necessary to treat intercarpal instability

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ORIF - Dorsoradiopalmar triple plate

Main indication: Gross articular injury which can be reconstructed

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*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