Distal Radius Fractures and Secondary Carpal Dysfunction

The goal of treatment of a distal radial fracture is to promote bone healing and prevent complications. If these goals are not achieved, the joint may become either stiff or unstable. Instability and stiffness are at the two ends of a spectrum of dysfunctions that may appear after a distal radial fracture. Instability would be characterized by excessive passive mobility (kinematic instability) and/or inability of sustaining physiologic loads without yielding (kinetic instability). Stiffness may allow resisting loads, but not to move normally. After a distal radius fracture, most carpal instabilities are secondary to radius malunion plus a variable degree of muscle imbalance and ligament insufficiency. Malunion and muscle imbalance may be prevented by proper fracture stabilization and muscle reeducation. Detecting ligament tears when the radius is fractured is not easy. When missed at presentation, chronic instability may appear. Certainly, it is difficult to discern which injuries are harmless and which are potential wrist destabilizers. This chapter will review how to diagnose and manage chronic carpal instabilities secondary to a distal radius fracture.