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

Surgical procedures sorted by fracture type

Use this menu to jump directly into a specific classification (optional):
A1.1 A1.2 A1.3 A2.1 A2.2 A2.3 A3 B1.1 B1.2 B1.3 B2.1 B2.2 B2.3 B3 C1 C2 C3
A1.1

Ulna: styloid fracture

Please select a treatment option:
Treatment Main indication Skill Equipment
Nonoperative treatment; casting Stable wrist and DRU joint Basic surgical experience, no specialized skills Basic equipment only
Open reduction; tension band wiring Unstable, small fragment Some specialized surgical experience Simple surgical and imaging resources
Open reduction; lag screw fixation Unstable, large fragment Some specialized surgical experience Simple surgical and imaging resources
A1.2

Ulna: simple metaphyseal fracture

Please select a treatment option:
Treatment Main indication Skill Equipment
Nonoperative treatment; casting Stable, undisplaced: reducible, transverse fracture Basic surgical experience, no specialized skills Basic equipment only
Open reduction; lag screw and protection plate Unstable fracture Some specialized surgical experience Simple surgical and imaging resources
Open reduction; compression plate Transverse, or short oblique fracture Some specialized surgical experience Simple surgical and imaging resources
A1.3

Ulna: multifragmentary metaphyseal fractures

Please select a treatment option:
Treatment Main indication Skill Equipment
Nonoperative treatment; casting Unfit or low-demand patient Basic surgical experience, no specialized skills Basic equipment only
Open reduction; bridge plating All 23-A1.3 fractures, where possible Highly experienced and skilled surgeon Simple surgical and imaging resources
Open reduction; hook plating All 23-A1.3 fractures, where possible Highly experienced and skilled surgeon Simple surgical and imaging resources
A2.1

Radius: extraarticular: undisplaced fracture

Please select a treatment option:
Treatment Main indication Skill Equipment
Nonoperative treatment; casting Almost all A2.1 fractures 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
Open reduction; palmar plating Severe shortening, late collapse, associated neurovascular injury Highly experienced and skilled surgeon Full specialized surgical and imaging resources
A2.2

Radius: extraarticular: dorsal tilt (Pouteau-Colles)

Please select a treatment option:
Treatment Main indication Skill Equipment
Nonoperative treatment; casting 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 fixation Unstable fractures, loss of reduction Some specialized surgical experience Simple surgical and imaging resources
Open reduction; palmar plating Unstable fracture, dorsal comminution, associated neurovascular injury Highly experienced and skilled surgeon Full specialized surgical and imaging resources
A2.3

Radius: extraarticular: volar tilt (Goyrand-Smith)

Please select a treatment option:
Treatment Main indication Skill Equipment
Nonoperative treatment; casting 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 fixation Unstable fractures, loss of reduction Some specialized surgical experience Simple surgical and imaging resources
Open reduction; palmar plating Irreducible, or unstable reduction, associated neurovascular injury Highly experienced and skilled surgeon Full specialized surgical and imaging resources
A3

Radius: extraarticular: multifragmentary

Please select a treatment option:
Treatment Main indication Skill Equipment
Nonoperative treatment; casting 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 fixation Unstable fractures, loss of reduction Some specialized surgical experience Simple surgical and imaging resources
Open reduction; palmar bridge plating Irreducible, or unstable reduction: associated neurovascular injury Highly experienced and skilled surgeon Full specialized surgical and imaging resources
B1.1

Partial articular: sagittal: lateral: simple

Please select a treatment option:
Treatment Main indication Skill Equipment
Nonoperative treatment; casting 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 fixation 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
Open reduction; palmar plating Failed, or unstable reduction Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Open reduction; radial column plating Failed, or unstable reduction Highly experienced and skilled surgeon Full specialized surgical and imaging resources
B1.2

Partial articular: sagittal: lateral: multifragmentary

Please select a treatment option:
Treatment Main indication Skill Equipment
Nonoperative treatment; casting 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
Open reduction; ORIF with lag screws/K-wires Displaced, irreducible Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Open reduction; radial column plating Failed, or unstable reduction Highly experienced and skilled surgeon Full specialized surgical and imaging resources
B1.3

Partial articular: sagittal: medial

Please select a treatment option:
Treatment Main indication Skill Equipment
Nonoperative treatment; casting 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
Open reduction; dorsal plating Failed or unstable articular reduction Highly experienced and skilled surgeon Full specialized surgical and imaging resources
B2.1

Partial articular: dorsal rim (Barton): simple

Please select a treatment option:
Treatment Main indication Skill Equipment
Nonoperative treatment; casting 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
Open reduction; dorsal plating Almost all 23-B2.1 fractures Highly experienced and skilled surgeon Full specialized surgical and imaging resources
B2.2

Partial articular: dorsal rim (Barton): with lateral sagittal fracture

Please select a treatment option:
Treatment Main indication Skill Equipment
Nonoperative treatment; casting 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
Open reduction; Dorsoradial double plating Almost all B2.2 fractures Highly experienced and skilled surgeon Full specialized surgical and imaging resources
B2.3

Partial articular: dorsal rim (Barton): with dorsal dislocation of the carpus

Please select a treatment option:
Treatment Main indication Skill Equipment
Nonoperative treatment; casting 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
Open reduction; dorsoradial double plating Almost all B2.3 fractures which involve a significant radial styloid fragment. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Open reduction; dorsal double plating Almost all B2.3 fractures which do not have a significant radial styloid fragment. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
B3

Partial articular: volar rim

Please select a treatment option:
Treatment Main indication Skill Equipment
Nonoperative treatment; casting 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
Open reduction; palmar plating Almost all 23-B3 fractures Highly experienced and skilled surgeon Full specialized surgical and imaging resources
C1

Simple articular: with simple metaphyseal injury

Please select a treatment option:
Treatment Main indication Skill Equipment
Nonoperative treatment; casting 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 fixation Reducible and large fragments, low demand patients Highly experienced and skilled surgeon Simple surgical and imaging resources
Open reduction; palmar plating Almost all 23-C1 fractures Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Open reduction; dorsoradial double plating When a posterior approach is necessary to treat intercarpal instability Highly experienced and skilled surgeon Full specialized surgical and imaging resources
C2

Simple articular: with comminuted metaphysis

Please select a treatment option:
Treatment Main indication Skill Equipment
Nonoperative treatment; casting 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 fixation Reducible and large fragments, low demand patients Highly experienced and skilled surgeon Simple surgical and imaging resources
Open reduction; palmar bridge plating Most C2 fractures with marked metaphyseal comminution Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Open reduction; dorsoradial double plating When a dorsal approach is necessary to treat intercarpal instability Highly experienced and skilled surgeon Full specialized surgical and imaging resources
C3

Multifragmentary articular fractures

Please select a treatment option:
Treatment Main indication Skill Equipment
Nonoperative treatment; casting 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
Open reduction; palmar bridge plating Marked metaphyseal comminution Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Open reduction; joint-spanning distraction plating Severe comminution Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Open reduction; dorsoradial double plating When a posterior approach is necessary to treat intercarpal instability Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Open reduction; dorsoradiopalmar triple plating 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