Fracture type (adults)
based on the mechanism of injury
Children fracture equivalent Stability/instability: high risk of secondary displacement after initial adequate reduction Displacement pattern No. of fragments Associated lesions: carpal ligament, fractures, median, ulnar, nerve, tendons, ipsilateral upper extremity, compartment syndrome Recommended treatment
Type I: bending fracture of the metaphysis Distal forearm fracture: Salter II Stable, unstable Nondisplaced
Dorsal (Colles-Pouteau)
Volar (Smith)
Proximal
Combined
Always two main fragments + varying degree of metaphyseal comminution (instability) Uncommon Conservative (stable fractures)
Percutaneous pinning (extra- or intrafocal)
External fixation
Exceptionally: bone graft
fernandez 2.3a
Type II: shearing fracture of the joint surface Salter IV Unstable Dorsal
Radial
Volar
Proximal
Combined
Two-part
Three-part
Comminuted
Less uncommon Open reduction Screwplate fixation
fernandez 2.3.b
Type III: compression fracture of the joint surface Salter III, IV, V Stable, unstable Nondisplaced
Dorsal
Radial
Volar
Proximal
Combined
Two-part
Three-part
Four-part
Comminuted
Common Conservative closed, limited, arthroscopic assisted, or extensile open reduction
Percutaneous pins combined external and internal fixation
Bone graft
fernandez 2.3.c
Type IV: avulsion fractures, radiocarpal fracture, dislocation Rare Unstable Dorsal
Radial
Volar
Proximal
Combined
Two-part (radial styloid ulnar styloid)
Three-part (volar, dorsal, margin)
Comminuted
Frequent Closed or open reduction
Pin or screw fixation
Tension wiring
fernandez 2.3.d
Type V: combined fractures (I, II, III, IV); high-velocity injury Rare Unstable Dorsal
Radial
Volar
Proximal
Combined
Comminuted and/or bone loss (frequently intraarticular, open, seldom extraarticular) always present Combined method
fernandez 2.3.e