[A reasonable algorithm for treatment of distal radius fractures]

Fracture of the distal radius is one of the commonest injuries affecting upper limb, particularly in the older age. To date, no optimal treatment of these fractures was determined, although in the past twenty years an increased tendency to operative treatment with stable plate fixation is observed. Authors personal observations indicate a common malpractice associated with treatment of these fractures in our country, resulting from unjustified acceptance of some false preconceptions. Hence, a proposal of a "reasonable" algorithm of the treatment appeared, a scheme allowing for management of many patients with the method providing acceptable reduction of the fracture and its maintenance until fracture union, and, performable in limited logistic and economical conditions. Suggested algorithm. Conservative treatment of distal radius fractures confined only to non- or minimally displaced fractures. All other cases with exceeding acceptable dislocation are candidates for surgery. The fractures no requiring--in assumption--a stable fixation: A2, A3, B1, C1 and C2 in AO classification we propose to treat with percutaneous K-wire pinning. Those, more unstable: B2, B3, C3, metaphyseal and high-energy A3 and C2 fractures in young adults we suggest to fix with volar locking plate. In C3, comminuted fractures and with severe soft tissue damage should be given external fixation. The proposed algorithm is a result of an experience collected in authors' institution, supported by evidence form literature. It confirmed its effectiveness in the reference department for hand injuries and it seems that it may contribute to improving the level of the treatment of distal radius fractures in our country.