General considerations
Partial articular fractures of the radius demand accurate reduction since they involve the articular surface. These fractures are unstable with dorsal subluxation of the carpus, therefore they should be treated operatively.
Any patient who has had a fall on the outstretched hand may have sustained an intercarpal ligament injury; these may easily be missed on initial clinical assessment.
Note: CT scans may be helpful for treatment decisions.
| Nonoperative treatment - Cast | ||
| Main indication | Skill | Equipment |
|---|---|---|
| Low-demand patient |  |
 |
Indication
- Low-demand patient
Contraindications
- Displacement
- Radiocarpal subluxation
- Open fractures
Disadvantages
- Risk of further displacement
-
Risk of radiocarpal subluxation
| Joint-spanning external fixation (temporary or definitive) | ||
| Main indication | Skill | Equipment |
|---|---|---|
| Temporary stabilization in polytrauma, unfit patient, insufficient hold in a cast, patient not suitable for ORIF |  |
 |
Indications
- Temporary stabilization in polytrauma
- Unfit patient
- Redisplacement in cast
- Open fracture
- Local soft-tissues compromised for plating
Contraindications
- Low-demand patient
- Patient not fit for surgery
- Poor state of local soft tissues increasing risk of pin track infection
Advantages
- Reduced risk of infection at the fracture site compared to open technique
- Lower risk in cases of significant local soft-tissue injury
- Restoration of extraarticular anatomy
- Loss of position unlikely
- Straightforward technique
- Less invasive than ORIF
Disadvantages
- Radial sensory nerve injury
- Risk of metacarpal fracture
- Risk of loss of radial length
- Risk of injury to extensor tendon
- Stiffness, especially with over distraction
- Risk of complex regional pain syndrome (type I) (CRPS-I)
- Pin-track infection
- Risk of redisplacement after removal
| ORIF - Dorsal plate | ||
| Main indication | Skill | Equipment |
|---|---|---|
| Almost all radial partial articular, dorsal rim, simple fractures |  |
 |
As these are articular injuries, with a high risk of radiocarpal subluxation, they should normally be fixed.
Indications
- Unstable injury
- Articular incongruity
- Radiocarpal subluxation
Contraindications
- Poor state of soft tissues
- Patient not fit for surgery
- Severe swelling
Advantages
- Stability in comminuted fractures
- Can be used in buttress mode Restoration of articular congruity
- Early motion
Disadvantages
- Risk of tendon irritation
-
Complexity of later implant removal
| *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 |