The management of distal radius fractures has evolved considerably in the last two decades. Techniques and hardware have improved so much that the surgeon can usually assure good results in these debilitating fractures. Yet no one method can be used for all injuries, as the personality of each fracture demands a customized approach. Furthermore, what works in one age group may not work in another. For this reason, every available treatment has its own space in our options. The need for surgeons to be well versed in all techniques is critical. We offer a concise update of important evolutionary and current treatment guidelines for this common fracture.
AdamsBDBergerRA (2002) An anatomic reconstruction of the distal radioulnar ligaments for posttraumatic distal radioulnar joint instability. J Hand Surg Am27: 243–51.
3.
AroraRLutzMDemlCKrappingerDHaugLGablM (2011) A prospective randomized trial comparing nonoperative treatment with volar locking plate fixation for displaced and unstable distal radial fractures in patients sixty-five years of age and older. J Bone Joint Surg Am93: 2146–53.
4.
AtzeiA (2009) New trends in arthroscopic management of Type 1-B TFCC injuries with DRUJ instability. J Hand Surg Eur34: 582–91.
5.
AugéWK2ndVelázquezPA (2000) The application of indirect reduction techniques in the distal radius: the role of adjuvant arthroscopy. Arthroscopy16: 830–35.
6.
BainGIAlexanderJJEngKDurrantAZumsteinMA (2013) Ligament origins are preserved in distal radial intraarticular two-part fractures: a computed tomography-based study. J Wrist Surg2: 255–62.
7.
BaratzMEDes JardinsJAndersonDDImbrigliaJE (1996) Displaced intra-articular fractures of the distal radius: the effect of fracture displacement on contact stresses in a cadaver model. J Hand Surg Am21: 183–8.
8.
BensonLSMinihaneKPSternLD, et al.(2009) The outcome of intraarticular distal radius fractures treated with fragment -specific fixation. J Hand Surg Am31: 1337–9.
9.
Borelli PP, Luchetti R. Treatment of the associated ulnar-sided problems. In: del Piñal F, Mathoulin C, Luchetti C (Eds.) Arthroscopic management of distal radius fractures. Berlin, Springer, 2010: 175–90.
10.
BuijzeGALeongNLStockmansF, et al.(2018) Three-dimensional compared with two-dimensional preoperative planning of corrective osteotomy for extra-articular distal radial malunion: a multicenter randomized controlled trial. J Bone Joint Surg Am100: 1191–202.
11.
CharlsonMSzatrowskiTPPetersonJGoldJ (1994) Validation of a combined comorbidity index. J Clin Epidemiol47: 1245–51.
12.
ChaudhryHKleinlugtenbeltYVMundiRRistevskiBGoslingsJCBhandariM (2015) Are volar locking plates superior to percutaneous K-wires for distal radius fractures? A meta-analysis. Clin Orthop Relat Res473: 3017–27.
13.
ClementNDGreenKMurrayNDuckworthADMcQueenMMCourt-BrownCM (2013) Undisplaced intracapsular hip fractures in the elderly: predicting fixation failure and mortality. A prospective study of 162 patients. J Orthop Sci18: 578–85.
14.
DanielRJoergGKurtKChristineVAndreasPBeateH (2015) The effect of local bone mineral density on the rate of mechanical failure after surgical treatment of distal radius fractures: a prospective multicentre cohort study including 249 patients. Arch Orthop Trauma Surg135: 201–7.
15.
del PiñalF (2011a) Technical tips for (dry) arthroscopic reduction and internal fixation of distal radius fractures. J Hand Surg Am36: 1694–705.
16.
del PiñalF (2011b) Dry arthroscopy and its applications. Hand Clin27: 335–45.
17.
del Piñal F. Distal radius malunion. In: Trail IA and Fleming ANM (Eds.) Disorders of the hand. London, Springer-Verlag, 2015: 129--51.
18.
del Piñal F del. Atlas of distal radius fractures. New York, Thieme, 2018.
19.
del Piñal F. Arthroscopic guided osteotomy for distal radius malunion. In: Mathoulin C (Ed.) Wrist arthroscopy techniques, 2nd Edn. New York, Thieme, 2019.
20.
del PiñalFCagigalLGarcía-BernalFJStuderARegaladoJThamsC (2010) Arthroscopically guided osteotomy for management of intra-articular distal radius malunions. J Hand Surg Am35: 392–7.
21.
del PiñalFGarcía-BernalFJDelgadoJSanmartínMRegaladoJCerezalL (2006) Correction of malunited intra-articular distal radius fractures with an inside-out osteotomy technique. J Hand Surg Am31: 1029–34.
22.
del PiñalFGarcía-BernalFJPisaniDRegaladoJAyalaHStuderA (2007) Dry arthroscopy of the wrist: surgical technique. J Hand Surg Am32: 119–23.
23.
del PiñalFGarcía-BernalFJStuderARegaladoJAyalaHCagigalL (2009) Sagittal rotational malunions of the distal radius: the role of pure derotational osteotomy. J Hand Surg Eur34: 160–5.
24.
del PiñalFKlausmeyerMMoraledaEde PieroGHRúasJS (2014) Arthroscopic reduction of comminuted intra-articular distal radius fractures with diaphyseal-metaphyseal comminution. J Hand Surg Am39: 835–43.
25.
del Piñal F, Mathoulin C, Luchetti R (Eds.) Arthroscopic management of distal radius fractures. Berlin, Springer-Verlag, 2010.
26.
DoiKHattoriYOtsukaKAbeYYamamotoH (1999) Intra-articular fractures of the distal aspect of the radius: arthroscopically assisted reduction compared with open reduction and internal fixation. J Bone Joint Surg Am81: 1093–110.
27.
EdwardsCC3rdHaraszticJMcGillivaryGRGutowAP (2001) Intra-articular distal radius fractures: arthroscopic assessment of radiographically assisted reduction. J Hand Surg Am26: 1036–41.
28.
Espejo-ReinaACarrascal-MorilloMTDelgado-MartinezAD (2021) Comparison of two different ways to apply a circular plaster cast for distal radius fractures: biomechanical study. J Orthop Surg Res16: 99.
29.
Fares AB, Childs BR, Polmear MM, Clark DM, Nesti LJ, Dunn JC. Dorsal bridge plate for distal radius fractures: a systematic review. J Hand Surg Am. Epub ahead of print 8 February 2021. DOI: 10.1016/j.jhsa.2020.11.026.
30.
Fernández DL, Jupiter JB. Surgical techniques. In: Fractures of the distal radius. A practical approach to management, 2nd edn. New York, Springer, 2002: 71–127.
31.
GeisslerWB (1995) Arthroscopically assisted reduction of intra-articular fracture of the distal radius. Hand Clinics11: 19–29.
32.
GinselBLTaherAOttleyMCJayamahaSPulleCRCrawfordRW (2014) Hospital mortality after arthroplasty using a cemented stem for displaced femoral neck fractures. J Orthop Surg (Hong Kong)22: 279–81.
33.
GradlGJupiterJPillukatTKnobeMPrommersbergerKJ (2013) Corrective osteotomy of the distal radius following failed internal fixation. Arch Orthop Trauma Surg133: 1173–9.
34.
GrewalRMacDermidJC (2007) The risk of adverse outcomes in extra-articular distal radius fractures is increased with malalignment in patients of all ages but mitigated in older patients. J Hand Surg Am32: 962–70.
35.
GrewalRMacDermidJCKingGJWFaberKJ (2011) Open reduction internal fixation versus percutaneous pinning with external fixation of distal radius fractures: a prospective, randomized clinical trial. J Hand Surg Am36: 1899–906.
36.
HarnessNGRingDZurakowskiDHarrisGJJupiterJB (2006) The influence of three-dimensional computed tomography reconstructions on the characterization and treatment of distal radial fractures. J Bone Joint Surg Am88: 1315–23.
37.
HaugstvedtJRBergerRANakamuraTNealePBerglundLAnKN (2006) Relative contributions of the ulnar attachments of the triangular fibrocartilage complex to the dynamic stability of the distal radioulnar joint. J Hand Surg Am31: 445–51.
38.
HaugstvedtJRLangerMFBergerRA (2017) Distal radioulnar joint: functional anatomy, including pathomechanics. J Hand Surg Eur42: 338–45.
39.
Henry M. TFCC: a DRUJ perspective. In: Piñal F del, Mathoulin C, Nakamura T (Eds). Arthroscopic management of ulnar pain. Berlin, Springer-Verlag, 2012: 121–35.
40.
IlyasAMJupiterJB (2010) Distal radius fractures—classification of treatment and indications for surgery. Hand Clin26: 37–42.
41.
JakobMRikliDARegazzoniP (2000) Fractures of the distal radius treated by internal fixation and early function. A prospective study of 73 consecutive patients. J Bone Joint Surg Br82: 340–4.
42.
Jupiter J, Chamas M, Buijze GA (Eds.) Distal radius fractures. Evidence-based management. Amsterdam, Elsevier, 2021.
43.
JupiterJBFernandezDL (1997) Comparative classification for fractures of the distal end of the radius. J Hand Surg Am22: 563–71.
44.
JupiterJBFernandezDLWhippleTLRichardsRR (1998) Intra-articular fractures of the distal radius: contemporary perspectives. Instr Course Lect47: 191–202.
45.
JupiterJBMarent-HuberMLCP Study Group (2009) Operative management of distal radial fractures with 2.4-millimeter locking plates. A multicenter prospective case series. J Bone Joint Surg Am91: 55–65.
46.
JupiterJBRingD (1996) A comparison of early and late reconstruction of malunited fractures of the distal end of the radius. J Bone Joint Surg Am78: 739–48.
47.
KalliniJRFuECShahASWatersPMBaeDS (2020) Growth disturbance following intra-articular distal radius fractures in the skeletally immature patient. J Pediatr Orthop40: e910–5.
48.
KnirkJLJupiterJB (1986) Intra-articular fractures of the distal end of the radius in young adults. J Bone Joint Surg Am68: 647–59.
49.
LanzUKronW (1976) Neue Technik zur Korrektur in Fehlstellung Verheilter Distaler Radiusfrakturen [A new technic for the correction of malunited distal radius fractures]. Handchirurgie8: 203–6.
50.
LenobleEDumontierCGoutallierDApoilA (1995) Fracture of the distal radius. A prospective comparison between trans-styloid and Kapandji fixations. J Bone Joint Surg Br77: 562–7.
51.
LenzMWahilDZdericI, et al.(2015) The concept of variable angle technology. J Orthop Res33: 988–92.
52.
LichtmanDMBindraRRBoyerMI, et al.(2011) American Academy of Orthopaedic Surgeons clinical practice guideline on: the treatment of distal radius fractures. J Bone Joint Surg Am93: 775–8.
53.
LidstromA (1959) Fractures of the distal end of the radius. A clinical and statistical study of end results. Acta Orthop Scand Suppl41: 1–118.
54.
LindauTArnerMHagbergL (1997) Intraarticular lesions in distal fractures of the radius in young adults: a descriptive arthroscopic study in 50 patients. J Hand Surg Br22: 638–43.
55.
LindauTHagbergLAdlercreutsCJonssonKAspengergP (2000) Distal radioulnar instability is an independent worsening facture in distal radius fractures. Clin Orthop Relat Res376: 229–35.
56.
LiverneauxPIchihanevSFaccaS, et al.(2016) Outcomes of minimally invasive plate osteosynthesis (MIPO) with volar locking plates in distal radius fractures: a review. Hand Surg Rehabil355: S80–5.
57.
LowSPapayMSpiesCKUnglaubFEingartnerC (2020) The requirement for closed reduction of dorsally displaced unstable distal radius fractures before operative treatment. Dtsch Arztebl Int117: 783–9.
58.
LutskyKBoyerMISteffenJAGoldfarbCA (2008) Arthroscopic assessment of intra-articular distal radius fractures after open reduction and internal fixation from a volar approach. J Hand Surg Am33: 476–84.
59.
MedoffRJ (2005) Essential radiographic evaluation for distal radius fractures. Hand Clin21: 279–88.
60.
MehtaJABainGIHeptinstallRJ (2000) Anatomical reduction of intra-articular fractures of the distal radius. An arthroscopically-assisted approach. J Bone Joint Surg Br82: 79–86.
61.
NakamuraTIwamotoTMatsumuraNSatoKToyamaY (2014) Radiographic and arthroscopic assessment of DRUJ instability due to foveal avulsion of the radioulnar ligament in distal radius fractures. J Wrist Surg3: 12–7.
62.
NakamuraTMoyOJPeimerCA (2021) Relationship between fracture of the ulnar styloid process and DRUJ instability: a biomechanical study. J Wrist Surg10: 111–5.
63.
NakamuraTObaraY (2015) The clinical outcome of anatomical re-attachment of the TFCC to the ulnar fovea using an ECU half-slip and interference screw. Handchir Mikrochir Plast Chir47: 290–6.
64.
NakamuraTSatoKOkazakiM, et al.(2011) Repair of foveal detachment of the triangular fibrocartilage complex: open and arthroscopic transosseous techniques. Hand Clin27: 281–90.
65.
NandyalaSVGiladiAMParkerAMRozentalTD (2018) Comparison of direct perioperative costs in treatment of unstable distal radial fractures: open reduction and internal fixation versus closed reduction and percutaneous pinning. J Bone Joint Surg Am100: 786--92.
66.
NellansKWKowalskiEChungKC (2012) The epidemiology of distal radius fractures. Hand Clin28: 113–25.
67.
NelsonGNStepanJGOseiDACalfeeRP (2015) The impact of patient activity level on wrist disability after distal radius malunion in older adults. J Orthop Trauma29: 195–200.
68.
OgawaTTanakaTYanaiTKumagaiHOchiaiN (2013) Analysis of soft tissue injuries associated with distal radius fractures. BMC Sports Sci Med Rehabil5: 19.
69.
OrbayJL (2000) The treatment of unstable distal radius fractures with volar fixation. Hand Surg5: 103–12.
70.
OrbayJLFernandezDL (2002) Volar fixation for dorsally displaced fractures of the distal radius: a preliminary report. J Hand Surg Am27: 205–15.
71.
OrbayJLFernandezDL (2004) Volar fixed-angle plate fixation for unstable distal radius fractures in the elderly patient. J Hand Surg Am29: 96–102.
72.
OrbayJLTouhamiAOrbayC (2012) Fixed angle fixation of distal radius fractures through minimally invasive approach. Tech Hand Upper Exty Surg9: 142–8.
73.
PalmerAK (1989) Triangular fibrocartilage complex lesions: a classification. J Hand Surg Am14: 594–606.
74.
ParkMJAhnJH (2005) Arthroscopically assisted reduction and percutaneous fixation of dorsal perilunate dislocations and fracture-dislocations. Arthroscopy21: 1153.
75.
PengFLiuYXWanZY (2018) Percutaneous pinning versus volar locking plate internal fixation for unstable distal radius fractures: a meta-analysis. J Hand Surg Eur43: 158–67.
76.
Piñal F del, Haerle M, Krimmer H. Distal radius fractures and carpal instabilities. Stuttgart, Thieme, 2019.
77.
PogueDJViegasSFPattersonRM, et al.(1990) Effects of distal radius malunion on wrist joint mechanics. J Hand Surg Am15: 721–7.
78.
PrommersbergerKJRingDGonzález del PinoJCapomassiMSlullitelMJupiterJB (2006) Corrective osteotomy for intra-articular malunion of the distal part of the radius. Surgical technique. J Bone Joint Surg Am88: S202–11.
79.
RichardMJKatolikLIHanelDPWartinbeeDARuchDS (2012) Distraction plating for the treatment of highly comminuted distal radius fractures in elderly patients. J Hand Surg Am37: 948–56.
80.
RichardsRSBennettJDRothJHMilneKJr (1997) Arthroscopic diagnosis of intra-articular soft tissue injuries associated with distal radius fractures. J Hand Surg Am22: 772–6.
81.
RingDJupiterJBBrennwaldJ, et al.(1997) Prospective multicenter trial of a plate for dorsal fixation of distal radius fractures. J Hand Surg Am22: 777–84.
82.
RingDPrommersbergerKJupiterJB (2004) Combined dorsal and volar plate fixation of complex fractures of the distal part of the radius. J Bone Joint Surg Am86: 1646–52.
83.
RingDRobergeCMorganTJupiterJB (2002) Osteotomy for malunited fractures of the distal radius: a comparison of structural and nonstructural autogenous bone grafts. J Hand Surg Am27: 216–22.
84.
RonerSSchweizerADa SilvaYCarrilloFNagyLFürnstahlP (2020) Accuracy and early clinical outcome after 3-dimensional correction of distal radius intra-articular malunions using patient-specific instruments. J Hand Surg Am45: 918–23.
85.
RozentalTDBlazarPEFrankoOIChackoATEarpBEDayCS (2009) Functional outcomes for unstable distal radial fractures treated with open reduction and internal fixation or closed reduction and percutaneous fixation. A prospective randomized trial. J Bone Joint Surg Am91: 1837–46.
86.
RuchDSValleeJPoehlingGGSmithBPKuzmaGR (2004) Arthroscopic reduction versus fluoroscopic reduction in the management of intra-articular distal radius fractures. Arthroscopy20: 225–30.
87.
SchumerEDLeslieBM (2005) Fragment-specific fixation of distal radius fractures using the Trimed device. Tech Hand Up Extrem Surg9: 74–83.
88.
SchweizerAFürnstahlPNagyL (2013) Three-dimensional correction of distal radius intra-articular malunions using patient-specific drill guides. J Hand Surg Am38: 2339–47.
89.
ShortWHPalmerAKWernerFWMurphyDJ (1987) A biomechanical study of distal radial fractures. J Hand Surg Am12: 529–34.
90.
SoongMEarpBEBishopGLeungABlazarP (2011) Volar locking plate implant prominence and flexor tendon rupture. J Bone Joint Surg Am93: 328–35.
91.
SouerJSRingDMatschkeSAudigeLMaren-HubertMJupiterJ (2010) Comparison of functional outcome after volar plate fixation with 2.4-mm titanium versus 3.5-mm stainless-steel plate for extra-articular fracture of distal radius. J Hand Surg Am35: 398–405.
92.
StrassmairMKJonasMSchäferWPalmerA (2016) Distal radial fracture management with an intramedullary cage and fragment fixation. J Hand Surg Am41: 833–40.
93.
TarasJSZambitoKLAbzugJM (2006) T-Pin for distal radius fracture. Tech Hand Up Extrem Surg10: 2–7.
94.
TeunisTJupiterJBJoerisA, et al.(2017) Evaluation of radiographic position one year after volar variable angle locking plate fixation. J Hand Surg Eur42: 493–500.
95.
TrumbleTESchmittSRVedderNB (1994) Factors affecting functional outcome of displaced intra-articular distal radius fractures. J Hand Surg Am19: 325–40.
96.
TumiaNWardlawDHallettJDeutmanRMattssonSASandenB (2003) Aberdeen Colles' fracture brace as a treatment for Colles' fracture. A multicentre, prospective, randomised, controlled trial. J Bone Joint Surg Br85: 78–82.
97.
von Laer L, Kraus R, Linhart WE. Frakturen und Luxationen im Wachstumsalter. Stuttgart, Thieme Verlag, 2013.
98.
WadaTIsogaiSKanayaKTsukaharaTYamashitaT (2004) Simultaneous radial closing wedge and ulnar shortening osteotomies for distal radius malunion. J Hand Surg Am29: 264–72.
99.
WadaTTatebeMOzasaY, et al.(2011) Clinical outcomes of corrective osteotomy for distal radial malunion: a review of opening and closing-wedge techniques. J Bone Joint Surg Am93: 1619–26.
100.
WadstenMASjodenGOButtazzoniGGButtazzoniCEnglundESayed-NoorAS (2018) The influence of late displacement in distal radius fractures on function, grip strength, range of motion and quality of life. J Hand Surg Eur43: 131–6.
101.
WagnerWFJrTencerAFKiserPTrumbleTE (1996) Effects of intra-articular distal radius depression on wrist joint contact characteristics. J Hand Surg Am21: 554–60.
102.
WernerFWPalmerAKFortinoMDShortWH (1992) Force transmission through the distal ulna: effect of ulnar variance, lunate fossa angulation, and radial and palmar tilt of the distal radius. J Hand Surg Am17: 423–8.
103.
WinkerKHRikliD (2012) Die distale Radiusfraktur Behandlungsstrategie beim Erwachsenen. Op-Journal28: 255–9.
104.
WongTCChiuYTsangWLLeungWYYamSKYeungSH (2010) Casting versus percutaneous pinning for extra-articular fractures of the distal radius in an elderly Chinese population: a prospective randomized controlled trial. J Hand Surg Eur35: 202–8.
