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Instructional Course Lectures, The American Academy of Orthopaedic Surgeons - Intra-Articular Fractures of the Distal Aspect of the Radius*
THOMAS E. TRUMBLE, M.D, SEATTLE; RANDALL CULP, M.D. PHILADELPHIA, PENNSYLVANIA; DOUGLAS P. HANEL, M.D., SEATTLE, WASHINGTON; WILLIAM B. GEISSLER, M.D.**, JACKSON, MISSISSIPPI; RICHARD A. BERGER, M.D, ROCHESTER, MINNESOTA
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J Bone Joint Surg Am, 1998 Apr 01;80(4):582-600
Introduction
High-energy injuries frequently cause shear and impacted fractures of the articular surface of the distal aspect of the radius with displacement of the fracture fragments. Even fractures with a small amount of displacement can result in degeneration of the joint, causing pain and stiffness of the wrist. The fracture pattern,degree of displacement of the fracture fragments, and stability of the fracture determine whether operative treatment rather than immobilization with a cast is needed. The options for operative treatment include open reduction and internal fixation, to realign the articular surface of the radius; external fixation, for fractures with comminution of the metaphysis of the radius, to maintain the lengthof the radius; and bone-grafting, to provide support for the articular surface of impacted fractures.
*Printed with permission of The American Academy of Orthopaedic Surgeons. This article will appear in Instructional Course Lectures, Volume 48, The American Academy of Orthopaedic Surgeons, Rosemont, Illinois, March 1999.
No benefits in any form have been received or will be received from acommercial party related directly or indirectly to the subject of this article. No funds were received in support of this study.
Department of Orthopaedics, University of Washington, Mailbox 356500, Seattle, Washington 98195.
Philadelphia Hand Center, 901 Walnut Street, Philadelphia, Pennsylvania 19107.
Harborview Medical Center, 325 Ninth Avenue, Box 359798, Seattle, Washington 98104-2499.Department of Orthopaedic Surgery, University of Mississippi Medical Center, 2500 North State Street, Jackson, Mississippi 39216.
Mayo Clinic, 200 First Street S. W., Rochester, Minnesota 55905.
Printed with permission of The American Academy of Orthopaedic Surgeons. This article will appear in Instructional Course Lectures, Volume 48, The American Academy of Orthopaedic Surgeons, Rosemont, Illinois,March 1999.
No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. No funds were received in support of this study.
Department of Orthopaedics, University of Washington, Mailbox 356500, Seattle, Washington 98195.
§Philadelphia Hand Center, 901 Walnut Street, Philadelphia, Pennsylvania 19107.Harborview Medical Center, 325 Ninth Avenue, Box 359798, Seattle, Washington 98104-2499.
Department of Orthopaedic Surgery, University of Mississippi Medical Center, 2500 North State Street, Jackson, Mississippi 39216.
Mayo Clinic, 200 First Street S. W., Rochester, Minnesota 55905.
 

Fig. 1 Schematic drawing showing the method for measurement of palmar tilt, distal radial tilt, and ulnar varianceon posteroanterior and lateral radiographs of the distal aspects of the radius and ulna.
 

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Fig. 2 Schematic drawing showing the distal articular surface of the radius, which is divided into the lunate and scaphoid facets.
 

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Fig. 3 Schematic drawing showing how fracture lines frequently propagate between the scaphoid and lunatefacets and extend dorsally adjacent to, but not through, the thicker bone that forms the Lister tubercle.
 

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Figs. 4, 5, and 6: Undecalcified specimen obtained from a sheep twelve weeks after a tibial osteotomy. Fig. 4: The fracture is still evident, with ongoing bone-remodeling. The low side (the depressed segment of the fracture), which has been unloaded by...