[Differential treatment of fractures of the distal radius]

Treatment of distal fractures of the radius has undergone considerable change during recent years. The cause for this lies primarily in the poor results of conservative treatments. In addition to osseous instability, the fractures of the radius are frequently combined with ligamentary instability as well, thereby exceeding the ability of conservative treatment. Among the many classifications, the AO classification of these fractures has proven to be the best and most widely accepted. This classification allows the recommendation of suitable procedures of treatment. The problem with inadequately healed fractures of the radius lies in the inherent unphysiological loading of the joint in the characteristic dorsal tilted position. This leads to a pathological displacement of the radius of flexion and extension and thereby to an overloading of the dorsal joint cartilage. The shortening of the radius leads to a mechanical impingement of the triangular fibrocartilagenous complex. The Kirschner wire fixation is particularly indicated in type A and type C fractures when combined with an external fixator. Of great importance here is the crossing of the K-wires, best accomplished by inserting an additional wire in a proximal to distal direction to achieve maximal mechanical stability. Biodegradable fixation devices are not yet in widespread use, as high costs and possible foreign body reactions have prevented their acceptance. The plate osteosynthesis has its domain in the treatment of volar luxation fractures (B3) and the partially articular fractures of the radius (B2). The domain of the external fixator, on the other hand, lies in the C2 and C3 fractures in combination with the K-wire osteosynthesis. Changing the mode of treatment to a plate osteosynthesis after two to three weeks allows a functional postoperative treatment. By use of a differentiated treatment regimen, the complication rate can be significantly reduced whose cause frequently lies in repeatedly attempted repositions. Nevertheless, a rupture of the tendon of the M. extensor pollicis longus takes place in a certain percentage of cases (less than 0.2%) due to the unusual vascularization of this tendon. The dystrophy of Sudeck has become a relatively rare occurrence. A connection between a compression syndrome of the median nerve and the dystrophy of Sudeck has been discussed. The differentiated management has led to a change from a purely conservative treatment to a more varied treatment of the fractures of the distal radius. In our own patients conservative treatment was carried out in 27.5%.