Fractures Of Wrist and Hand

Angga Fiandana

Distal Radius Fractures

Introduction
Distal radius fractures occur through the distal
metaphysis of the radius, frequently involving the
ulnar styloid as well.
Most often result from a fall on the outstretched
hand.
Associated injuries may accompany distal radius
fractures.

Introduction
Classified by:
presence or absence of intraarticular involvement,
degree of comminution,
dorsal vs. volar displacement,
involvement of the distal
radioulnar joint.

Treatment Goals
Preserve hand and wrist function
Avoid complications
Restore anatomy where necessary and
appropriate

Osseous Anatomy
Distal radius 80% of axial load
Distal ulna 20%

Acceptability
Radial inclination = 23 (13 -30 )
Radial length = 11 (8-18) mm
Palmar tilt = 0-28 (11-12)

Measurement of Radial Length and Inclination

Inclination =
23 degrees

Frykman Classification
Extraarticular
Radio-carpal
joint
Radio-ulnar
joint
Both joints

Same pattern
as right, except
ulnar styloid
also fractured

AO OTA Classification
Group A:
Extra-articular

Group B:
Partial Intraarticular
Group C:
Complete
Intra-articular

Dorsal angulation and comminution

Options for Treatment

Casting
External Fixation
Joint-spanning
Non joint-spanning

Percutaneous pinning
Internal Fixation
Dorsal plating
Volar plating
Combined dorsal/volar plating

Indications for Closed Treatment

Low-energy fracture
Low-demand patient
Non-dominant hand
Medical co-morbidities