Management of High Energy Distal Radius Injuries

  • Janice J. HeEmail author
  • Philip Blazar
Distal Radius and Wrist Fractures (E Shin, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Distal Radius and Wrist Fractures


Purpose of Review

High energy distal radius are commonly multi-fragmentary with significant comminution and/or bone loss. They can also be associated with ligamentous and soft tissue injury and neurovascular compromise. As such, reconstruction of these injuries can be challenging. This paper will review the relevant anatomy, different methods of fixation, and present techniques for difficult fractures.

Recent Findings

Volar locked plating is a successful, very common method of treatment for distal radius fractures, but dorsal plating, fragment specific fixation, spanning bridge plating, and external fixation are sometimes necessary, particularly in higher energy injuries characterized by metaphyseal comminution, small volar fragments, intra-articular free fragments or lunate facet subsidence. Extended flexor carpi radialis (FCR), dorsal, and flexor carpi ulnaris (FCU) exposures can assist in visualizing the fracture site.


There are many different modes of fixation for distal radius fractures, and successful outcome depends on selection of appropriate fixation based on the fracture pattern and status of the soft tissues.


Distal radius Hand trauma Comminuted fracture Articular fracture Open reduction internal fixation 


Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Medoff RJ. Essential radiographic evaluation for distal radius fractures. Hand Clin. 2005;21(3):279–88.CrossRefGoogle Scholar
  2. 2.
    Chen NC, Jupiter JB. Management of Distal Radial Fractures. JBJS. 2007;89:2051–62.Google Scholar
  3. 3.
    Martineau PA, Berry GK, Harvey E. Plating for distal radius fractures. Orthop Clin N Am. 2007;38:193–201.CrossRefGoogle Scholar
  4. 4.
    •• Beck JD, Harness NG, Spencer HT. Volar plate fixation failure for volar shearing distal radius fractures with small lunate facet fragments. J Hand Surg [Am]. 2014;39:670–8 This prospective study followed the outcomes of patients with AO B3 distal radius fractures fixed with volar locking plates and consequently identified risk factors of implant failure. This is important as it concretely identified situations in which fragment specific fixation should be considered over volar locked plating. CrossRefGoogle Scholar
  5. 5.
    Lutsky K, Boyer M, Goldfarb C. Dorsal locked plate fixation of distal radius fractures. J Hand Surg [Am]. 2013;38:1414–22.CrossRefGoogle Scholar
  6. 6.
    Farhan MF, Wong JH, Sreedharan S, Yong FC, Teoh LC. Combined volar and dorsal plating for complex comminuted distal radial fractures. J Orthop Surg (Hong Kong). 2015;23:19–23.CrossRefGoogle Scholar
  7. 7.
    Wang D, Shan L, Jun-Lin Z. Locking plate versus external fixation for type C distal radius fractures: a meta-analysis of randomized control trials. Chin J Traumatol. 2018;21:113–7.CrossRefGoogle Scholar
  8. 8.
    • Saving J, Enocson A, Ponzer S, Mellstrand Navarro C. External fixation versus volar locking plate for unstable dorsally displaced distal radius fractures: a 3-year follow up of a randomized control study. J Hand Surg [Am]. 2019;44:18–26 Popularity for external fixation has waxed and waned and has recently been less popular due to concerns about complications. However, this study shows that 3 year results between external fixation and volar locked plating are comparable. CrossRefGoogle Scholar
  9. 9.
    Roh YH, Lee BK, Baek JR, Noh JH, Gong HS, Baek GH. A randomized comparison of volar plate and external fixation for intra-articular distal radius fractures. J Hand Surg. 2015;40:34–41.CrossRefGoogle Scholar
  10. 10.
    Wei DH, Poolman RW, Bhandari M, Wolfe VM, Rosenwasser MP. External fixation versus internal fixation for unstable distal radius fractures: a systematic review and meta-analysis of comparative clinical trials. J Orthop Trauma. 2012;26:386–94.CrossRefGoogle Scholar
  11. 11.
    Cross AW, Schmidt CC. Flexor tendon injuries following locked volar plating of distal radius fractures. J Hand Surg [Am]. 2008;33:164–7.CrossRefGoogle Scholar
  12. 12.
    • Kamal RN, LEversedge F, Ruch DS, Mithani SK, Cotterell IHF, Richard MJ. The Sigmoid Notch View for Distal Radius Fractures. J Hand Surg [Am]. 2018;43:1038 This study describes the sigmoid notch view, which can be one method of ensuring there is no intra-articular screw penetration. CrossRefGoogle Scholar
  13. 13.
    Kitay A, Swanstrom M, Schreiber JJ, Carlson MG, Nguyen JT, Weiland AJ, et al. Volar plate position and flexor tendon rupture following distal radius fracture fixation. J Hand Surg [Am]. 2013;38:1091–6.CrossRefGoogle Scholar
  14. 14.
    Kurylo JC, Axelrad TW, Tornetta P, Jawa A. Open fractures of the distal radius: the effect of delayed debridement and immediate internal fixation on infection rates and the need for secondary procedures. J Hand Surg [Am]. 2011;36:1131–4.CrossRefGoogle Scholar
  15. 15.
    Glueck DA, Charoglu CP, Lawton JN. Factors associated with infection following open distal radius fractures. Hand. 2009;4:330–4.CrossRefGoogle Scholar
  16. 16.
    Weber D, Dulai SK, Bergman J. Time to initial operative treatment following open fracture does not impact development of deep infection: a prospective cohort study. J Orthop Trauma. 2014;28:613–9.CrossRefGoogle Scholar
  17. 17.
    Srour M, Inaba K, Okoye O. Prospective evaluation of treatment of open fractures: effect of time to irrigation and debridement. JAMA Surg. 2015;150:332–6.CrossRefGoogle Scholar
  18. 18.
    Roberts RS, Bennett JD, Roth JH, Milne K. Arthroscopic diagnosis of intra-articular soft tissue injuries associated with distal radius fractures. J Hand Surg [Am]. 1997;22:772–6.Google Scholar
  19. 19.
    Lundau T, Arner M, Hagberg L. Intraarticular lesions in distal radius fractures in young adults: a descriptive arthroscopic study in 50 patients. J Hand Surg (Br). 1997;22:638–43.CrossRefGoogle Scholar
  20. 20.
    Geissler WB, Freelane AE, Savoie FH, McIntyre LW, Whipple TL. Intracarpal soft tissue lesions associated with an intra-articular fracture of the distal end of the radius. J Bone Joint Surg Am. 1996;78:357–65.CrossRefGoogle Scholar
  21. 21.
    Kordaziewicz B, Podgorski A, Kilch M, Michalik D, Chaberek S, Pomianowski S. Arthroscopic assessment of intra-articular distal radius fractures-results of minimally invasive fixation. Orthop Traumatol Rehabil. 2011;13:369–86.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Orthopaedic SurgeryBrigham and Women’s HospitalBostonUSA

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