Distal radius Fracture Discussion
Distal radius fractures account for about one out of every six of fractures
seen in the emergency room and three out of four forearm fractures. They
are most common in both sexes between 6 and 10 years and in women between
60 and 69 years old. They may be classified by a number of schemes, the
simplest being nondisplaced, displaced extraarticular and displaced
intraarticular. A large number of operative and nonoperative treatment
options have been recommended, many of which appear to give comparable
results. Operative treatments include external fixation, percutaneous
pinning, open reduction, and any combination of these. Poor final outcome
is more likely when the fracture is initially very displaced, when the
distal radioulnar joint is involved, and when the radiocarpal joint is
comminuted. The importance of setting the fracture and accurately
realigning the fragments is controversial. There are conflicting reports
regarding the importance of final fracture alignment on function, although
it is agreed that it is the primary reason for residual deformity following
fracture. Reflex sympathetic dystrophy and finger stiffness occur to some
degree in as many as one out of three patients. Loss of motion is also
common, but unpredictable. Median or ulnar nerve compression may develop
early or late following this fracture. Tendon rupture may follow this
injury. Posttraumatic arthritis may develop, and is most common in young
adults, seen in radiographs of two out of three young patients evaluated
years after injury. Fortunately, radiographs do not correlate well with the
degree of symptoms, and many of these patients are asymptomatic. Carpal
instability may develop, either as a discrete ligament injury or as a
result of changes in the radiocarpal joint angle. Nonunion of associated
ulnar styloid fractures is common and usually painless. Prolonged (six to
twelve months) recovery is typical, as are long term subjective symptoms,
such as pain, fatigability, and loss of grip strength. Such symptoms can
be expected to in about half of patients with a non-compensation related
injury; in about four out of five adult patients under the age of 45, and
in essentially all patients with compensation-related injury. Despite this,
three out of four patients on the average have a satisfactory functional
result following distal radius fracture.
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