Executive Editor: Steve Krikler

Authors: Renato Fricker, Jesse Jupiter, Matej Kastelec

Distal forearm Extraarticular undisplaced fracture of the radius

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Glossary

General considerations

These fractures involve neither the radiocarpal, nor the distal radioulnar joints, affecting only the radial metaphysis. They are undisplaced, or impacted, but exhibit no abnormal palmar or dorsal tilt.
They tend to be relatively stable and may often be treated nonoperatively.

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.

Nonoperative treatment - Cast
Main indication Skill Equipment
Almost all radial extraarticular simple fractures with no displacement/tilt Basic surgical experience, no specialized skills Basic equipment only

Indication

Indicated for patients with no associated injuries

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 Some specialized surgical experience Simple surgical and imaging resources

Indications

  • Temporary stabilization in polytrauma
  • Unstable fracture
  • 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 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 - Palmar plate
Main indication Skill Equipment
Severe shortening, late collapse, associated neurovascular injury Highly experienced and skilled surgeon Full specialized surgical and imaging resources

If the bone is significantly osteoporotic there is an increased risk of early shortening or late collapse.

Indications

  • Shortening of the radial metaphysis, with relative ulnar overlength
  • Late collapse
  • Associated neurovascular injury
  • Unstable injury

Contraindications

  • Patient not fit for surgery
  • Poor state of soft tissues

Advantages

  • Anatomical restoration of radial length
  • Minimal risk of redisplacement
  • Early motion

Disadvantage

  • Cost
*Skill
Basic surgical experience, no specialized skills Basic surgical experience, no specialized skills
Some specialized surgical experience Some specialized surgical experience
Highly experienced and skilled surgeon Highly experienced and skilled surgeon
*Equipment
Basic equipment only Basic equipment only
Simple surgical and imaging resources Simple surgical and imaging resources
Full specialized surgical and imaging resources Full specialized surgical and imaging resources