Executive Editor: Steve Krikler

Authors: Renato Fricker, Jesse Jupiter, Matej Kastelec

Distal forearm Partial articular, sagittal fracture of the radius, involving the lunate fossa

back to skeleton

Glossary

General considerations

These partial articular fractures of the radius demand accurate reduction since they may involve the articular surfaces of both the radiocarpal and distal radioulnar joints.

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: 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
  • Redisplacement following reduction
  • Instability
  • Open fracture
  • 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 - Dorsal plate
Main indication Skill Equipment
Failed or unstable articular reduction Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Indications

  • Unacceptable displacement
  • Failure of less invasive methods
  • Instability of distal radioulnar joint
  • High-demand patients
  • Open fractures
  • Intercarpal ligament injury (especially scapholunate diastasis)

Contraindications

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

Advantages

  • Stability of fixation
  • Early motion
  • Articular congruity with reduced risk of degenerative joint disease

Disadvantages

  • Risk of tendon irritation
  • More complex implant removal than lag screw
  • Possible need for 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