[An instability of the fractures of the distal radius--a review]

Many fractures of the distal radius, particularly articular and comminuted are considered unstable what result in secondary displacement in the course of the treatment, necessity of repeated reduction or delayed operative treatment. These fractures should be primarily given surgery, since their conservative treatment will probably fail. The objective of this article was to review literature about criteria of instability of the fractures of the distal radius, an attempt to define instability pattern and to propose a practical approach to the problem. Of the analyzed factors indicating instability, the following: radial shortening, degree of dorsal or volar tilt, dorsal comminution, articular involvement and older age of the patient revealed their greatest prognostic significance. The degree of the radial inclination or radial shift had a minor prognostic value. Greater number of factors elevates the risk of instability of the fracture, however the presence of the only one or two factors does not warrant maintenance of the adequate reduction. In more than half of the fractures of the distal radius, secondary displacement occur later than 2 weeks after the reduction, what suggest need of radiological control during the full period of the immobilization. An operative treatment of distal radius fractures significantly reduces rate of secondary displacements and risk of malunion. An increase of indication to surgery of the majority of fractures of the distal radius meeting at least one of above mentioned criteria of instability seems to be reasonable, although difficult therapeutic algorithm.