Articular fractures of the distal radius

Fractures of the distal radius are frequently articular injuries resulting in disruption of both the radiocarpal and distal radioulnar joints. The articular fracture comprises four basic components: (1) radial shift; (2) radial styloid; (3) dorsal medial fragment; and (4) palmar medial fragment. The medial fragments and their strong ligamentous attachments with the proximal carpals and ulnar styloid have been termed the medial complex, and its displacement is the basis for a useful classification into four fracture types. Type I fractures are undisplaced, or they are stable after closed reduction with preservation of the joint surfaces. Type II fractures are comminuted and unstable, with displacement of the medial complex as a unit, and are best managed with continuous skeletal traction. Type III spike fractures demonstrate displacement of the medial complex as a unit as well as displacement of an additional fragment from the comminuted radial shaft. The spike fragment characteristically causes injury to an adjacent nerve or tendon and requires excision or replacement along with repair of the soft tissue at the time of skeletal fixation. Type IV split fractures require open reduction and internal fixation for an accurate repair of the disrupted distal radial articular surfaces. The unstable articular fractures are frequently associated with serious concomitant nerve, tendon, or skeletal injury, which may be recognized and often repaired at the time of fracture treatment. These injuries are usually the result of violent trauma, and contrary to common opinion, they do not characteristically occur among the elderly. Optimal management of distal radial fractures requires early recognition and repair of articular disruption and may associate soft tissue or skeletal injury. Precise reduction of the medial complex consistently restores biarticular congruity and generally results in a superior recovery of wrist function.