Distal Radial Fractures
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Search Strategy[edit | edit source]
Search Datebases:Cochrane Library, Medline with full text, pubmed, CINAHL, Search dates: 9/16, 9/21, 10/26.
Search terms: Distal radial fracture, distal radius fracture, distal radial treatment, distal radius treatment, radius physical therapy, RCT
Definition/Description
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Fractures occurring in the distal radius often occur in both children and adults and can be referred to as “wrist fractures.” They are defined as occurring in the distal radius within three centimeters from the radiocarpal joint, where the radius interfaces with the lunate and scaphoid bone of the wrist. The majority of distal radial fractures are closed injuries in which the overlying skin remains intact (Handoll et al 2008—EF).
Epidemiology /Etiology[edit | edit source]
Distal radial fractures in adults is one of the most common fractures, accounting for one-sixth of all fractures in the emergency department and can be seen predominantly in the white and older population. (Abrama, Bienek, Kay, Handoll (EF)) In women, the incidence of occurrence increases with age starting at 40 years old, whereas before this age the incidence in men is much higher. Occurrences in younger adults are usually the result of a high-energy trauma, such as a motor vehicle accident. In older adults, such fractures are often the result of a low-energy or moderate trauma, such as falling from standing height. This may reflect the greater fragility of the bone due to osteoporosis in the older adult. (Handoll (EF), Leung)
Distal radial fractures account for up to 72% of all forearm fractures and 8-17% of all extremity fractures. (Bushnell). Historically, literature has focused on restoring the anatomic radiocarpal alignment, however the distal radioulnar joint (DRUJ) is also important in restoring hand function.(Kleinman)
Multiplanar wrist motion is based on three articulations: radioscaphoid, radiolunate, and distal radioulnar joints. The distal end of the radius forms a “platform” to support the functional demands of the wrist. The medial distal radius ligament and ulnar-syloid based triangular fibrocartilage complex (TFCC) help to stabilize the wrist. (Bushnell) The TFCC is the primary intrinsic stabilizer of the DRUJ and is critical for normal DRUJ biomechanics. (Kleinman) Bony anatomy can result in malunions with radiographic assessment by measuring the radial inclination, radial length, ulnar variance and radial tilt (Figure X). Slight changes may result in malunion and can cause considerable pain and disability. For example, increased dorsal angulation can alter the loading force and result in decreased congruency at the DRUJ thus tightening the interosseous membrane and decreasing pronation-supination.(Bushnell) A concomminant injury due to stress on the TFCC is an avulsion fracture of the ulnar styloid process and can result in significant malalignment. (Kleinman)
A correlation between the severity of the primary displacement and the expectant loss of reduction over a time period is assumed when treating distal radial fractures with immobilization. Predictive factors of instability at an early (1 week) and a late (6 weeks) time period can be established by radial shortening and dorsal tilt in the early phases and radial shortening, dorsal tilt, and decreased radial inclination in the late phases. Instability is defined as dorsal tilt >15°, volar tilt >20°, ulnar variance >4mm and a radial inclincation <10°(split into table) (Leone, Bushnell)
Characteristics/Clinical Presentation[edit | edit source]
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Examination[edit | edit source]
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Medical Management (current best evidence)[edit | edit source]
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Physical Therapy Management (current best evidence)[edit | edit source]
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