Executive Editor: Steve Krikler

Authors: Renato Fricker, Jesse Jupiter, Matej Kastelec

Distal forearm Partial articular, sagittal multifragmentary radial fracture, involving scaphoid fossa

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
Minimally displaced fracture, low-demand patient Basic surgical experience, no specialized skills Basic equipment only

Indications

  • Minimally displaced fracture
  • Low-demand patient

Contraindications

  • Displacement
  • Associated intercarpal ligament injury

Disadvantages

  • Risk of displacement
  • Risk of uneven joint surface, leading to early degenerative joint disease
  • Sequelae of untreated intercarpal ligament injury
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
  • Open fracture
  • Insufficient hold in a cast
  • Local soft-tissues compromised for plating

Contraindications

  • Poor state of local soft tissues increasing risk of pin track infection
  • Patient not fit for surgery

Advantages

  • Reduced risk of infection at the fracture site compared to plating
  • Lower risk in cases of significant local soft-tissue injury than ORIF
  • Straightforward technique

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 - Lag screws/K-wires
Main indication Skill Equipment
Displaced, irreducible Highly experienced and skilled surgeon Full specialized surgical and imaging resources

The surgeon may prefer to use cannulated screws, if they are available.

Indications

  • No significant articular incongruity
  • Redisplacement after reduction
  • Displacement with significant articular step
  • Irreducible fracture
  • High-demand patients
  • Open fractures

Contraindications

  • Intercarpal ligament injury (scapholunate diastasis)
  • Osteoporosis
  • Poor state of soft tissues

Advantages

  • Less invasive than plate fixation
  • Less complex than ORIF
  • Less time consuming than ORIF
  • Lower cost than ORIF
  • Restoration of articular congruity
  • Reduced risk of early degenerative joint disease
  • Early motion

 Disadvantages

  • Risk of injury to superficial branch of radial nerve
  • Risk of tendon irritation
  • Possible need for later implant removal
ORIF - Radial column plate
Main indication Skill Equipment
Failed, or unstable reduction Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Indications

  • Failure of attempted closed reduction
  • Redisplacement after reduction
  • Irreducible fracture
  • High-demand patients
  • Open fractures
  • Associated intercarpal ligament injury (scapholunate diastasis)

Contraindications

  • Patient not fit for surgery
  • Poor state of local soft tissues
  • Severe swelling

Advantages

  • Stability of fixation
  • Early motion
  • Anatomical reduction
  • Reduced risk of early degenerative joint disease

 Disadvantages

  • Risk of tendon irritation
  • Risk of radial sensory nerve injury
  • More complex procedure than lag screw
  • Possible need for later implant removal, more complex removal than lag screw
*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