Executive Editor: Steve Krikler

Authors: Renato Fricker, Jesse Jupiter, Matej Kastelec

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

back to skeleton

Glossary

General considerations

Partial articular fractures of the radius demand accurate reduction since they involve the articular surface.

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
Patient not fit for surgery, low demand patient Basic surgical experience, no specialized skills Basic equipment only

These fractures should only ever be treated nonoperatively in very low demand or unfit patients.

Indications

  • Low-demand patient
  • Patient not fit for surgery
  • Poor state of soft tissues

Contraindication

  • Open fractures, if condition of patient permits surgery

Disadvantages

  • Severe risk of redisplacement and radiocarpal dislocation
  • Poor functional outcome
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
  • 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 - Dorsoradial double plate
Main indication Skill Equipment
Almost all radial dorsal rim fractures, involving the scaphoid fossa Highly experienced and skilled surgeon Full specialized surgical and imaging resources

As these are articular injuries, with a high risk of radiocarpal subluxation, they should normally be fixed. 

Contraindications

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

Advantages

  • Stability in comminuted fractures
  • Access for intercarpal ligament repair
  • Restoration of articular surface
  • Early motion

Disadvantages

  • Technically demanding
  • Risk of tendon irritation
  • More complex later implant removal
*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