Distal Radius Fractures

Patients with distal radius fractures most often present with wrist pain and deformity immediately after a fall. All patients with wrist pain after a fall should have AP, lateral,

Figure 30-23 Postoperative radiograph with scapholunate joint reduced and two K wires properly positioned to stabilize the joint.

(From Nicholas J, Hershman E. The Upper Extremity in Sports Medicine, 2nd ed. St Louis, Mosby, 1995, p 393.)

Figure 30-23 Postoperative radiograph with scapholunate joint reduced and two K wires properly positioned to stabilize the joint.

(From Nicholas J, Hershman E. The Upper Extremity in Sports Medicine, 2nd ed. St Louis, Mosby, 1995, p 393.)

and oblique radiographs of the wrist. Deformity may or may not be present, and some patients may complain of pares-thesias in the affected extremity. A patient's ability to move the wrist does not rule out fracture. It is important to palpate the entire extremity to assess any injury above or below the primary injury site for concomitant fractures. If suspected, radiograph those areas as well. Neurovascular status should always be evaluated and documented.

Treatment is based on fracture type, patient age, and demand. A nondisplaced or minimally displaced fracture can be initially treated in a splint for 5 to 7 days until swelling subsides, then casted in a short-arm cast. Average healing time is 4 to 8 weeks, and repeat radiographs should be obtained during the healing process at an interval of every 2 to 3 weeks. An extra-articular, angulated fracture is initially treated with closed reduction with block (lidocaine injection into fracture hematoma). If postreduction alignment is adequate, a splint can be placed for 5 to 7 days to maintain the alignment pending casting. Because displacement or angulation of fracture fragments is a high risk even when appropriately splinted or casted, radiographic follow-up is important, and distal radius fractures are often treated by an orthopedic surgeon. Comminuted or displaced intra-articular fractures usually require closed reduction with percutaneous pinning or open reduction, internal fixation to maintain position and articular surface integrity; orthopedic surgery referral is recommended.

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