Advances in Distal Radius Fracture Management

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Advances in Distal Radius Fracture Management
O p e r a t i v e C o n s i d e r a t i o n s
Jesse B. Jupiter, M.D.
Orthopaedic Hand Service Massachusetts General
Hospital Boston, Massachusetts
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A Rationale For Care

• Who is the patient?
• What are the fracture problems?
• What are the treatment problems?
• What can the patient tolerate?
• What really influences outcome?
• What is the cost?

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Distal Radius Fracture
Edinburgh 1990 - 1992 2141 Fractures

• 515 Male
• Average age 43 years (Range, 16-92 years)
• 1626 Female
• Average age 65 years (Range, 16-100 years)

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D i s t a l R a d i u sStructural Anatomy
C h a n g i n g P e r s p e c t i v e s
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Fracture Stability
Column Theory - Medoff
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Fracture Stability
Column Theory - Rikkli Regazzoni
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Volar Metaphyseal Fracture Comminution
Smith Fracture -- AO A3.2

• Volar plate application
• Avoid dorsal translation of distal fragment

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Volar Metaphyseal Fracture Comminution
P r o b l e m

• Dorsal translation

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Volar Shearing
Bartons Fracture -- AO B.3

• Buttress plate
• Most fractures have 2 or more fragments

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Unstable Volar Displaced(Smiths) Fracture Of
The Distal Radius
Choon-lai Toh, M.D Jesse B. Jupiter, M.D. Diego
L. Fernandez, M.D. Thomas Fellman, M.D.
Jupiter J et al, J Bone Joint Surg 78A 1996
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Classification
(Fernandez) Intraarticular (48)
A Anterior shear radial styloid 2 B Anterior
marginal (Shear) 4 C Two-part anterior
marginal 22 D Comminuted anterior marginal 18
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Volar Shearing Fracture
P r o b l e m

• Incomplete support

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Rotated Volar Lunate Facet
Compression Fracture -- AO C3.2

• Radial column and dorsal lunate facet can be
  manipulated and pinned
• Rotated volar lunate facet requires ORIF

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Complex Dorsal Articular Fracture
Radiocarpal Fracture-dislocation -- AO B2.3

• Dorsal exposure and radiocarpal arthrotomy
• ORIF radial and ulnar styloid

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Complex Fracture Patterns

• Extensive comminution involving all columns
• Complex articular fracture with metaphyseal
  comminution
• May require dorsal and volar plate fixation

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Combined Injuries

• Carpal fracture
• Compartment syndrome
• Unstable ulnar neck fracture
• Proximal limb injury

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THANK YOU !!
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