Executive Editor: Steve Krikler

Authors: Renato Fricker, Jesse Jupiter, Matej Kastelec

Distal forearm

back to skeleton

Glossary

Basic treatment techniques

Basic technique: Modular external fixation

Extraarticular fracture of the ulnar styloid process

Please select a treatment option:
Treatment Main indication Skill Equipment
Nonoperative treatment - Cast Stable wrist and DRU joint Basic surgical experience, no specialized skills Basic equipment only
ORIF - Tension band wire Unstable, small fragment Some specialized surgical experience Simple surgical and imaging resources
ORIF - Lag screw Unstable, large fragment Some specialized surgical experience Simple surgical and imaging resources

Extraarticular simple fracture of the ulna

Please select a treatment option:
Treatment Main indication Skill Equipment
Nonoperative treatment - Cast Stable, undisplaced: reducible, transverse fracture Basic surgical experience, no specialized skills Basic equipment only
ORIF - Lag screw and protection plate Unstable fracture Some specialized surgical experience Simple surgical and imaging resources
ORIF - Compression plate Transverse, or short oblique fracture Some specialized surgical experience Simple surgical and imaging resources

Extraarticular multifragmentary fracture of the ulna

Please select a treatment option:
Treatment Main indication Skill Equipment
Nonoperative treatment - Cast Unfit or low-demand patient Basic surgical experience, no specialized skills Basic equipment only
ORIF - Bridge plate All ulnar multifragmentary extraarticular fractures, where possible Highly experienced and skilled surgeon Simple surgical and imaging resources
ORIF - Hook plate All ulnar multifragmentary extraarticular fractures, where possible Highly experienced and skilled surgeon Simple surgical and imaging resources

Extraarticular undisplaced fracture of the radius

Please select a treatment option:
Treatment Main indication Skill Equipment
Nonoperative treatment - Cast Almost all radial extraarticular simple fractures with no displacement/tilt Basic surgical experience, no specialized skills Basic equipment only
Joint-spanning external fixation (temporary or definitive) 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
ORIF - Palmar plate Severe shortening, late collapse, associated neurovascular injury Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Extraarticular fracture of the radius with dorsal displacement or tilt

Please select a treatment option:
Treatment Main indication Skill Equipment
Nonoperative treatment - Cast Reducible fracture in absence of dorsal comminution Basic surgical experience, no specialized skills Basic equipment only
Joint-spanning external fixation (temporary or definitive) 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
Closed reduction - K-wires and cast/external fixator Unstable fractures, loss of reduction Some specialized surgical experience Simple surgical and imaging resources
ORIF - Palmar plate Unstable fracture, dorsal comminution, associated neurovascular injury Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Extraarticular fracture of the radius with volar displacement or tilt

Please select a treatment option:
Treatment Main indication Skill Equipment
Nonoperative treatment - Cast Reducible fracture in absence of palmar comminution Basic surgical experience, no specialized skills Basic equipment only
Joint-spanning external fixation (temporary or definitive) 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
Closed reduction - K-wires and cast/external fixator Unstable fractures, loss of reduction Some specialized surgical experience Simple surgical and imaging resources
ORIF - Palmar plate Irreducible, or unstable reduction, associated neurovascular injury Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Extraarticular wedge or multifragmentary fracture of the radius

Please select a treatment option:
Treatment Main indication Skill Equipment
Nonoperative treatment - Cast Low-demand patient; surgery not possible Basic surgical experience, no specialized skills Basic equipment only
Joint-spanning external fixation (temporary or definitive) 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
Closed reduction - K-wires and cast/external fixator Unstable fractures, loss of reduction Some specialized surgical experience Simple surgical and imaging resources
ORIF - Palmar bridge plate Irreducible, or unstable reduction: associated neurovascular injury Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Partial articular, sagittal simple radial fracture, involving scaphoid fossa

Please select a treatment option:
Treatment Main indication Skill Equipment
Nonoperative treatment - Cast Minimally displaced fracture, low demand patient Basic surgical experience, no specialized skills Basic equipment only
Joint-spanning external fixation (temporary or definitive) 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
Closed reduction - K-wires and cast/external fixator Unstable fractures, loss of reduction Some specialized surgical experience Simple surgical and imaging resources
Closed reduction - Lag screws Displaced, reducible, no intercarpal ligament instability Highly experienced and skilled surgeon Simple surgical and imaging resources
ORIF - Palmar plate Failed, or unstable reduction Highly experienced and skilled surgeon Full specialized surgical and imaging resources
ORIF - Radial column plate Failed, or unstable reduction Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Partial articular, sagittal multifragmentary radial fracture, involving scaphoid fossa

Please select a treatment option:
Treatment Main indication Skill Equipment
Nonoperative treatment - Cast Minimally displaced fracture, low-demand patient Basic surgical experience, no specialized skills Basic equipment only
Joint-spanning external fixation (temporary or definitive) 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
ORIF - Lag screws/K-wires Displaced, irreducible Highly experienced and skilled surgeon Full specialized surgical and imaging resources
ORIF - Radial column plate Failed, or unstable reduction Highly experienced and skilled surgeon Full specialized surgical and imaging resources

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

Please select a treatment option:
Treatment Main indication Skill Equipment
Nonoperative treatment - Cast Minimally displaced: low-demand patient Basic surgical experience, no specialized skills Basic equipment only
Joint-spanning external fixation (temporary or definitive) 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
ORIF - Dorsal plate Failed or unstable articular reduction Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Partial articular, simple fracture of the radius, involving the dorsal rim

Please select a treatment option:
Treatment Main indication Skill Equipment
Nonoperative treatment - Cast Low-demand patient Basic surgical experience, no specialized skills Basic equipment only
Joint-spanning external fixation (temporary or definitive) 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
ORIF - Dorsal plate Almost all radial partial articular, dorsal rim, simple fractures Highly experienced and skilled surgeon Full specialized surgical and imaging resources

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

Please select a treatment option:
Treatment Main indication Skill Equipment
Nonoperative treatment - Cast Patient not fit for surgery, low demand patient Basic surgical experience, no specialized skills Basic equipment only
Joint-spanning external fixation (temporary or definitive) 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
ORIF - Dorsoradial double plate Almost all radial dorsal rim fractures, involving the scaphoid fossa Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Partial articular fracture of the radius, with dorsal dislocation

Please select a treatment option:
Treatment Main indication Skill Equipment
Nonoperative treatment - Cast Patient not fit for surgery, low demand patient Basic surgical experience, no specialized skills Basic equipment only
Joint-spanning external fixation (temporary or definitive) 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
ORIF - Dorsoradial double plate Almost all partial articular fractures which involve a significant radial styloid fragment. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
ORIF - Dorsal double plate Almost all partial articular fractures which involve a significant radial styloid fragment Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Partial articular fracture of the radius, involving the volar rim

Please select a treatment option:
Treatment Main indication Skill Equipment
Nonoperative treatment - Cast Low-demand patient; surgery contraindicated Basic surgical experience, no specialized skills Basic equipment only
Joint-spanning external fixation (temporary) 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
ORIF - Palmar plate Almost all Goyrand-Smith II fractures Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Complete simple articular, simple metaphyseal radial fracture

Please select a treatment option:
Treatment Main indication Skill Equipment
Nonoperative treatment - Cast Unfit or low-demand patient, undisplaced fracture Basic surgical experience, no specialized skills Basic equipment only
Joint-spanning external fixation (temporary or definitive) 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
Closed reduction - K-wires and cast/external fixator Reducible and large fragments, low demand patients Highly experienced and skilled surgeon Simple surgical and imaging resources
ORIF - Palmar plate Almost all complete articular simple fractures of the radius Highly experienced and skilled surgeon Full specialized surgical and imaging resources
ORIF - Dorsoradial double plate When a posterior approach is necessary to treat intercarpal instability Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Complete simple articular, fragmented metaphysis radial fracture

Please select a treatment option:
Treatment Main indication Skill Equipment
Nonoperative treatment - Cast Unfit or low-demand patient, undisplaced fracture Basic surgical experience, no specialized skills Basic equipment only
Joint-spanning external fixation (temporary or definitive) 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
Closed reduction - K-wires and cast/external fixator Reducible and large fragments, low demand patients Highly experienced and skilled surgeon Simple surgical and imaging resources
ORIF - Palmar bridge plate Most complete articular fractures with marked metaphyseal comminution Highly experienced and skilled surgeon Full specialized surgical and imaging resources
ORIF - Dorsoradial double plate When a dorsal approach is necessary to treat intercarpal instability Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Complete multifragmentary fracture of the radius

Please select a treatment option:
Treatment Main indication Skill Equipment
Nonoperative treatment - Cast Unfit or low-demand patient, undisplaced fracture Basic surgical experience, no specialized skills Basic equipment only
Joint-spanning external fixation (temporary or definitive) 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
ORIF - Palmar bridge plate Marked metaphyseal comminution Highly experienced and skilled surgeon Full specialized surgical and imaging resources
ORIF - Joint-spanning distraction plate Severe comminution Highly experienced and skilled surgeon Full specialized surgical and imaging resources
ORIF - Dorsoradial double plate When a posterior approach is necessary to treat intercarpal instability Highly experienced and skilled surgeon Full specialized surgical and imaging resources
ORIF - Dorsoradiopalmar triple plate Gross articular injury which can be reconstructed Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Special considerations

Principles of management of open fractures
Complications
Infection
Compartment syndrome
*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