Surgical Techniques

Abstract

Reduction of fractures of the distal radius will in most cases be obtained by applying a force opposite to that which produced the injury. Thus an understanding of the mechanism of injury proves extremely useful in deciding upon the appropriate reduction maneuvers. Dorsal bending-type fractures (Colles’) exhibit increased dorsal angulation, shortening, and radial deviation and supination of the distal fragment. Palmar bending fractures (Smith’s) have a reverse deformity pattern, with the distal fragment deviated in a palmar direction and with variable degrees of shortening and pronation with reference to the ulnar. Classically, dorsal bending fractures are reduced by applying longitudinal traction, palmar flexion, ulnar deviation, and pronation (Fig. 4.1).¹² Restoration of skeletal length in displaced and impacted fractures may be readily obtained by increasing the initial deformity until one cortex engages the other. This contact point is then used as a fulcrum to realign both fragments with a flexion maneuver. The principle of reduction is based upon the application of tension on the soft tissue hinges located on the concavity of the angulation.

Acknowledging then the frequency of this fracture and the repeated failures attending its treatment, thus causing a partial, if not total loss of the use of the hand and fingers to a great number of our fellow-beings, it will be readily conceded that any rational plan, by which a more favorable result may be obtained is worthy the notice of the profession. H.M. Shaw, Esq., 1847