When a distal radius fracture is complex or unstable, it will most likely require a surgical approach to ensure the fracture stays in place during the healing process.

External Fixation

An unstable fracture, particularly one that extends into the wrist’s radiocarpal joint (intra-articular), may be a good candidate for a surgical procedure known as external fixation. This approach entails placing into the bone metal pins that extend outside the surface of the skin. The pins are then attached to a rigid external frame to keep them in place. Once the fracture is healed, the pins and frame are removed.

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There are a few options for how the pins are held in place:

  • Bridging external fixation involves a frame that extends across the wrist joint, keeping the wrist in a static position. A bridging fixator can be made more dynamic with the addition of a hinge in the frame.
  • Non-bridging external fixation involves a frame that does not bridge the wrist joint, allowing for movement earlier in the recovery process.

Kirschner wires also may be used to supplement the fixator, although they typically won’t be attached to the fixation frame.

A few studies have shown that non-bridging external fixation may lead to better results.2,3 This approach has the added benefit of earlier mobility, as it doesn’t keep the wrist in a fixed position. The biggest drawbacks to external fixator are the cumbersome frame and the potential for infection at the pin sites.

Internal Plate Fixation

Internal fixation, where plates and screws are implanted to hold the bone fragments in place without external caging, has the advantage of allowing earlier mobilization of the wrist without complicated casting.

An increasingly popular treatment approach to a distal radius fracture is to surgically implant plates, screws, or pins to hold the bone fragments in place. Plates and other components are most often implanted on the inside of the wrist and forearm, but it is possible to implant them on the back of the arm and wrist in certain circumstances. The components are not removed even after the bone heals (although if supplemental Kirschner wires are used, those will be removed).

As with external fixation, this approach is appropriate for unstable, intra-articular, compound and/or comminuted fractures. Compared with external fixation, internal plating has the advantage of allowing earlier mobilization and less complicated casting. The biggest drawback is its potential effect of irritating tendons near the components, causing tendinopathy and possible tendon rupture. However, the risk of this complication is decreasing as more newly designed plates have a thinner profile.

By working with their physician, patients can find the best treatment option for distal radius fracture to meet their expectations and lifestyle.

References:

  1. Hayes AJ, Duffy PJ, Mcqueen MM. Bridging and non-bridging external fixation in the treatment of unstable fractures of the distal radius: a retrospective study of 588 patients. Acta Orthop. 2008;79(4):54
  2. Modi CS, Ho K, Smith CD, Boer R, Turner SM. Dynamic and static external fixation for distal radius fractures--a systematic review. Injury. 2010;41(10):1006-11.
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