Comminuted Articular Distal Radius Fractures

Abstract Comminuted, intraarticular distal radial fractures present a substantial management challenge. Typically, the result of higher energy injuries they can also occur during fractures in osteopenic bone. While all injuries have the potential for ongoing disability and functional impairment, overall fracture severity of the distal radius has been shown to be correlated with inferior health-related quality of life and radiographic outcomes. In the setting of complex articular fracture pattern, a number of techniques have been described. Regardless of treatment modality, surgical goals remain the restoration of alignment, length and re-establishing articular congruency. Despite a variety of available surgical techniques to aid in the management of these complex intraarticular distal radius fractures, strong evidence to support the superiority of any one technique remains limited. Each technique brings with it specific advantages and complications. Despite a lack of scientific consensus, volar plating has become the mainstay of conventional treatment for distal radius fractures. However, highly comminuted articular fractures may present specific challenges for this technique. This is particularly the case when complex articular comminution, and shear patterns are present where higher rates of complications and poorer radiographic outcomes have been reports. Despite evidence to support improved radiological congruency using many of these techniques, inferior functional outcomes regardless of reduction are common in these complex injuries. This finding likely represents the inherent chondral injury present despite radiographic osseous reduction. Further complicating the issue is the lack of clear relationship between radiographic outcome and functional/clinical outcomes, particularly in the elderly.