Summary Distal radius fractures are the most common orthopaedic injury and generally result from fall on an outstretched hand. Diagnosis is made clinically and radiographically with orthogonal radiographs of the wrist Treatment can be nonoperative or operative depending on fracture stability and fracture displacement as well as patient age and activity demands Epidemiology Incidence accounts for 17.5% of all fractures in adults login to view 1 more bullet Demographics more common in females (2-3:1) bimodal distribution login to view 3 more bullets Anatomic location Approximately 65% extra-articular, 10% partial articular, and 25% complete Risk factors osteoporosis login to view 3 more bullets Etiology Pathophysiology mechanism of injury login to view 2 more bullets Associated conditions DRUJ injuries radial styloid fractures login to view 1 more bullet soft tissue injuries - seen in 70% login to view 3 more bullets Anatomy Osteology distal radius login to view 38 more bullets Classification Fernandez based on mechanism of injury Frykman based on joint involvement (radiocarpal and/or radioulnar) +/- ulnar styloid fracture Melone divides intra-articular fractures into 4 types based on displacement AO comprehensive but cumbersome Eponyms Eponyms Name Description Illustration X-ray Die-punch fx Depressed fracture of the lunate fossa of the articular surface of the distal radius Volar Barton Fracture-dislocation of radiocarpal joint with intra-articular fx involving the volar lip Dorsal Barton Fracture-dislocation of radiocarpal joint with intra-articular fx involving the dorsal lip Chauffer's fx Transverse or oblique radial styloid fx Colles' fx Dorsally angulated, extra-articular fx Smith's fx Volarly angulated, extra-articular fx Presentation History usually a fall onto outstretched hand (FOOSH) Symptoms wrist pain wrist swelling wrist deformity Physical exam inspection login to view 3 more bullets motion login to view 1 more bullet Imaging Radiographs recommended views login to view 3 more bullets findings Radiographic criteria Measurement Normal Acceptable criteria Radial height (AP) 13mm < 5mm shortening Radial inclination (AP) 23° Change < 5° Articular stepoff (AP) Congruous < 2 mm stepoff Volar tilt (Lateral) 11° Dorsal angulation < 5° or within 20° of contralateral distal radius CT indications login to view 2 more bullets MRI indications login to view 4 more bullets Treatment Nonoperative closed reduction and immobilization login to view 6 more bullets Operative closed reduction percutaneous pinning (CRPP) login to view 4 more bullets open reduction internal fixation (ORIF) login to view 15 more bullets external fixation (Exfix) login to view 8 more bullets Techniques Closed reduction and immobilization technique login to view 24 more bullets CRPP technique login to view 3 more bullets complications specific to this treatment login to view 2 more bullets ORIF technique guides login to view 2 more bullets types login to view 12 more bullets technique login to view 6 more bullets complications specific to this treatment login to view 4 more bullets outcomes login to view 1 more bullet External fixation technique guides login to view 2 more bullets types login to view 4 more bullets technique login to view 4 more bullets complications specific to this treatment login to view 6 more bullets Complications Median nerve neuropathy (CTS) incidence login to view 2 more bullets risk factors login to view 1 more bullet treatment login to view 4 more bullets Ulnar nerve neuropathy risk factors login to view 1 more bullet EPL rupture risk factors login to view 3 more bullets treatment login to view 1 more bullet FPL rupture risk factors login to view 2 more bullets Radiocarpal arthrosis (2-30%) incidence login to view 1 more bullet may also be nonsymptomatic Malunion/nonunion intra-articular malunion login to view 2 more bullets extra-articular angulation malunion login to view 4 more bullets radial shortening malunion login to view 3 more bullets ECU or EDM entrapment risk factors login to view 1 more bullet Compartment syndrome RSD/CRPS prevention login to view 3 more bullets Prognosis Poor functional outcomes associated with worker's compensation low socioeconomic status low education levels low bone density Successful outcomes correlate with accuracy of articular reduction restoration of anatomic relationships early efforts to regain motion of wrist and fingers