Distal radial fractures

These are the commonest fractures in adults, particularly the elderly. Distal radial fractures may be extra- or intra-articular, displaced or undisplaced and comminuted (Fig. 22.5). Grossly unstable fractures with significant dorsal angulation and displacement of the distal radial fragments usually involves a high degree of comminution with radial shortening and are often associated with a fracture of the ulnar styloid (Fig. 22.6). The commonest way of immobilizing relatively uncomplicated fractures of the distal radius is closed reduction with

Figure 22.6. Comminuted displaced intra-articular fracture of the distul radius.

local, regional or general anaesthesia and immobilization for 4-6 weeks in a well-moulded below-elbow cast. Complicated fractures may require either the application of an external fix-ator or open reduction and internal fixation with metallic plate, screws and pins. A significant bony defect remains once acceptable reduction has been achieved and fixation may need to be augmented with an autogenous bone graft, synthetic bone substitutes or bone cement.

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