Pre-Operative Assessment in Distal Radius Fractures

  • Gregory I. BainEmail author


The determinants of clinical outcome following distal radial fracture are multi-factorial and may provide several challenges to the treating surgeon. These can be considered under the following headings: patient history including medical co-morbidities, functional demands and injury history; examination findings including the condition of the soft tissue envelope and neurological status; radiographic parameters including fracture characteristics, articular involvement, stability features and associated injuries to the ulna or carpus. Finally, classification of the injury may aid treatment selection and prognostic prediction. With vigilant pre-operative planning, the surgeon can ensure the best outcome for an individual patient.



To co-authors Daniel G Mandziak, M.B.B.S., Royal Adelaide Hospital and Adam C Watts M.B.B.S., F.R.C.S.(Tr and Ortho), Modbury Public Hospital, Adelaide, Australia for their contribution to this chapter.


  1. 1.
    Abbaszadegan H, Jonsson U, von Sivers K. Prediction of instability of Colles’ fractures. Acta Orthop Scand. 1989;60: 646–50CrossRefPubMedGoogle Scholar
  2. 2.
    Andersen DJ, Blair WF, Steyers CM Jr, et al. Classification of distal radius fractures: an analysis of interobserver reliability and intraobserver reproducibility. J Hand Surg [Am]. 1996;21:574–82CrossRefGoogle Scholar
  3. 3.
    Apergis E, Darmanis S, Theodoratos G, et al. Beware of the ulno-palmar distal radial fragment. J Hand Surg [Br]. 2002; 27:139–45Google Scholar
  4. 4.
    Auge WK II, Velazquez PA. The application of indirect reduction techniques in the distal radius: the role of adjuvant arthroscopy. Arthroscopy. 2000;16:830–5CrossRefPubMedGoogle Scholar
  5. 5.
    Bacorn RW, Kurtzke JF. Colles’ fracture; a study of two thousand cases from the New York State Workmen’s Compensation Board. J Bone Joint Surg Am. 1953;35-A: 643–58PubMedGoogle Scholar
  6. 6.
    Bauman TD, Gelberman RH, Mubarak SJ, et al. The acute carpal tunnel syndrome. Clin Orthop Relat Res. 1981;(156): 151–6Google Scholar
  7. 7.
    Berger RA. The anatomy of the ligaments of the wrist and distal radioulnar joints. Clin Orthop Relat Res. 2001;(383): 32–40Google Scholar
  8. 8.
    Capo JT, Accousti K, Jacob G, et al. The effect of rotational malalignment on X-rays of the wrist. J Hand Surg Eur. 2009; 34:166–72Google Scholar
  9. 9.
    Cassebaum WH. Colles’ fracture; a study of end results. J Am Med Assoc. 1950;143:963–5PubMedGoogle Scholar
  10. 10.
    Cole RJ, Bindra RR, Evanoff BA, et al. Radiographic evaluation of osseous displacement following intra-articular fractures of the distal radius: reliability of plain radiography versus computed tomography. J Hand Surg [Am]. 1997;22: 792–800CrossRefGoogle Scholar
  11. 11.
    Cooney WP III, Linscheid RL, Dobyns JH. External pin fixation for unstable Colles’ fractures. J Bone Joint Surg Am. 1979;61:840–5PubMedGoogle Scholar
  12. 12.
    del Piñal F. Dry arthroscopy of the wrist: its role in the management of articular distal radius fractures. Scand J Surg. 2008;97:298–304PubMedGoogle Scholar
  13. 13.
    del Piñal F, Garcia-Bernal FJ, Pisani D, et al. Dry arthroscopy of the wrist: surgical technique. J Hand Surg Am. 2007; 32:119–23CrossRefPubMedGoogle Scholar
  14. 14.
    Epner RA, Bowers WH, Guilford WB. Ulnar variance–the effect of wrist positioning and roentgen filming technique. J Hand Surg [Am]. 1982;7:298–305Google Scholar
  15. 15.
    Fernandez DL. Fractures of the distal radius: operative treatment. Instr Course Lect. 1993;42:73–88PubMedGoogle Scholar
  16. 16.
    Flinkkila T, Nikkola-Sihto A, Kaarela O, et al. Poor interobserver reliability of AO classification of fractures of the ­distal radius. Additional computed tomography is of minor value. J Bone Joint Surg Br. 1998;80:670–2CrossRefGoogle Scholar
  17. 17.
    Flinkkila T, Nikkola-Sihto A, Raatikainen T, et al. Role of metaphyseal cancellous bone defect size in secondary displacement in Colles’ fracture. Arch Orthop Trauma Surg. 1999;119:319–23CrossRefPubMedGoogle Scholar
  18. 18.
    Forward DP, Davis TR, Sithole JS. Do young patients with malunited fractures of the distal radius inevitably develop symptomatic post-traumatic osteoarthritis? J Bone Joint Surg Br. 2008;90:629–37PubMedGoogle Scholar
  19. 19.
    Friberg S, Lundstrom B. Radiographic measurements of the radio-carpal joint in normal adults. Acta Radiol Diagn (Stockh). 1976;17:249–56Google Scholar
  20. 20.
    Frykman G. Fracture of the distal radius including sequelae–shoulder-hand-finger syndrome, disturbance in the distal radio-ulnar joint and impairment of nerve function. A clinical and experimental study. Acta Orthop Scand Suppl. 1967; 108:103+Google Scholar
  21. 21.
    Gelberman RH, Salamon PB, Jurist JM, et al. Ulnar variance in Kienbock’s disease. J Bone Joint Surg Am. 1975;57:674–6PubMedGoogle Scholar
  22. 22.
    Graham TJ. Surgical correction of malunited fractures of the distal radius. J Am Acad Orthop Surg. 1997;5:270–81PubMedGoogle Scholar
  23. 23.
    Harness NG, Ring D, Zurakowski D, et al. The influence of three-dimensional computed tomography reconstructions on the characterization and treatment of distal radial fractures. J Bone Joint Surg Am. 2006;88:1315–23CrossRefPubMedGoogle Scholar
  24. 24.
    Howard PW, Stewart HD, Hind RE, et al. External fixation or plaster for severely displaced comminuted Colles’ fractures? A prospective study of anatomical and functional results. J Bone Joint Surg Br. 1989;71:68–73PubMedGoogle Scholar
  25. 25.
    Johnston GH, Friedman L, Kriegler JC. Computerized tomographic evaluation of acute distal radial fractures. J Hand Surg [Am]. 1992;17:738–44CrossRefGoogle Scholar
  26. 26.
    Jupiter JB, Fernandez DL. Comparative classification for fractures of the distal end of the radius. J Hand Surg [Am]. 1997;22:563–71CrossRefGoogle Scholar
  27. 27.
    Katz MA, Beredjiklian PK, Bozentka DJ, et al. Computed tomography scanning of intra-articular distal radius fractures: does it influence treatment? J Hand Surg [Am]. 2001; 26:415–21CrossRefGoogle Scholar
  28. 28.
    Kazuki K, Kusunoki M, Shimazu A. Pressure distribution in the radiocarpal joint measured with a densitometer designed for pressure-sensitive film. J Hand Surg [Am]. 1991; 16:401–8CrossRefGoogle Scholar
  29. 29.
    Knirk JL, Jupiter JB. Intra-articular fractures of the distal end of the radius in young adults. J Bone Joint Surg Am. 1986;68:647–59PubMedGoogle Scholar
  30. 30.
    Koh S, Andersen CR, Buford WL Jr, et al. Anatomy of the distal brachioradialis and its potential relationship to distal radius fracture. J Hand Surg [Am]. 2006;31:2–8CrossRefGoogle Scholar
  31. 31.
    Kopylov P, Johnell O, Redlund-Johnell I, et al. Fractures of the distal end of the radius in young adults: a 30-year follow-up. J Hand Surg [Br]. 1993;18:45–9Google Scholar
  32. 32.
    Kreder HJ, Hanel DP, McKee M, et al. Consistency of AO fracture classification for the distal radius. J Bone Joint Surg Br. 1996;78:726–31PubMedGoogle Scholar
  33. 33.
    Kreder HJ, Hanel DP, McKee M, et al. X-ray film measurements for healed distal radius fractures. J Hand Surg [Am]. 1996;21:31–9CrossRefGoogle Scholar
  34. 34.
    Lafontaine M, Hardy D, Delince P. Stability assessment of distal radius fractures. Injury. 1989;20:208–10CrossRefPubMedGoogle Scholar
  35. 35.
    Lewis MH. Median nerve decompression after Colles’s fracture. J Bone Joint Surg Br. 1978;60-B:195–6PubMedGoogle Scholar
  36. 36.
    Lidstrom A. Fractures of the distal end of the radius. A clinical and statistical study of end results. Acta Orthop Scand Suppl. 1959;41:1–118PubMedGoogle Scholar
  37. 37.
    Lindau T, Adlercreutz C, Aspenberg P. Peripheral tears of the triangular fibrocartilage complex cause distal radioulnar joint instability after distal radial fractures. J Hand Surg [Am]. 2000;25:464–8CrossRefGoogle Scholar
  38. 38.
    Lozano-Calderon SA, Doornberg J, Ring D. Fractures of the dorsal articular margin of the distal part of the radius with dorsal radiocarpal subluxation. J Bone Joint Surg Am. 2006;88:1486–93CrossRefPubMedGoogle Scholar
  39. 39.
    Lundy DW, Quisling SG, Lourie GM, et al. Tilted lateral radiographs in the evaluation of intra-articular distal radius fractures. J Hand Surg [Am]. 1999;24:249–56CrossRefGoogle Scholar
  40. 40.
    Mackenney PJ, McQueen MM, Elton R. Prediction of instability in distal radial fractures. J Bone Joint Surg Am. 2006; 88:1944–51CrossRefPubMedGoogle Scholar
  41. 41.
    McQueen M, Caspers J. Colles fracture: does the anatomical result affect the final function? J Bone Joint Surg Br. 1988;70:649–51PubMedGoogle Scholar
  42. 42.
    Medoff RJ. Essential radiographic evaluation for distal radius fractures. Hand Clin. 2005;21:279–88.CrossRefPubMedGoogle Scholar
  43. 43.
    Melone CP Jr. Articular fractures of the distal radius. Orthop Clin North Am. 1984;15:217–36PubMedGoogle Scholar
  44. 44.
    Melone CP Jr. Open treatment for displaced articular fractures of the distal radius. Clin Orthop Relat Res. 1986;(202): 103–11Google Scholar
  45. 45.
    Melone CP Jr. Distal radius fractures: patterns of articular fragmentation. Orthop Clin North Am. 1993;24:239–53PubMedGoogle Scholar
  46. 46.
    Miyake T, Hashizume H, Inoue H, et al. Malunited Colles’ fracture. Analysis of stress distribution. J Hand Surg [Br]. 1994;19:737–42Google Scholar
  47. 47.
    Nesbitt KS, Failla JM, Les C. Assessment of instability factors in adult distal radius fractures. J Hand Surg [Am]. 2004;29:1128–38CrossRefGoogle Scholar
  48. 48.
    Orbay JL, Fernandez DL. Volar fixed-angle plate fixation for unstable distal radius fractures in the elderly patient. J Hand Surg [Am]. 2004;29:96–102CrossRefGoogle Scholar
  49. 49.
    Orbay JL, Touhami A. Current concepts in volar fixed-angle fixation of unstable distal radius fractures. Clin Orthop Relat Res. 2006;445:58–67PubMedGoogle Scholar
  50. 50.
    Palmer AK. The distal radioulnar joint. Anatomy, biomechanics, and triangular fibrocartilage complex abnormalities. Hand Clin. 1987;3:31–40PubMedGoogle Scholar
  51. 51.
    Palmer AK, Glisson RR, Werner FW. Ulnar variance determination. J Hand Surg [Am]. 1982;7:376–9Google Scholar
  52. 52.
    Pogue DJ, Viegas SF, Patterson RM, et al. Effects of distal radius fracture malunion on wrist joint mechanics. J Hand Surg [Am]. 1990;15:721–7CrossRefGoogle Scholar
  53. 53.
    Porter M, Stockley I. Fractures of the distal radius. Intermediate and end results in relation to radiologic parameters. Clin Orthop Relat Res. 1987;220:241–52PubMedGoogle Scholar
  54. 54.
    Pruitt DL, Gilula LA, Manske PR, et al. Computed tomography scanning with image reconstruction in evaluation of distal radius fractures. J Hand Surg [Am]. 1994;19:720–7CrossRefGoogle Scholar
  55. 55.
    Richards RS, Bennett JD, Roth JH, et al. Arthroscopic diagnosis of intra-articular soft tissue injuries associated with distal radial fractures. J Hand Surg [Am]. 1997;22:772–6CrossRefGoogle Scholar
  56. 56.
    Sarmiento A. The brachioradialis as a deforming force in Colles’ fractures. Clin Orthop Relat Res. 1965;38:86–92PubMedGoogle Scholar
  57. 57.
    Shih JT, Lee HM, Hou YT, et al. Arthroscopically-assisted reduction of intra-articular fractures and soft tissue management of distal radius. Hand Surg. 2001;6:127–35CrossRefPubMedGoogle Scholar
  58. 58.
    Simpson NS, Jupiter JB. Delayed onset of forearm compartment syndrome: a complication of distal radius fracture in young adults. J Orthop Trauma. 1995;9:411–8CrossRefPubMedGoogle Scholar
  59. 59.
    Smaill GB. Long-term follow-up of Colles’s fracture. J Bone Joint Surg Br. 1965;47:80–5PubMedGoogle Scholar
  60. 60.
    Souer JS, Ring D, Matschke S, et al. Effect of an unrepaired fracture of the ulnar styloid base on outcome after plate-and-screw fixation of a distal radial fracture. J Bone Joint Surg Am. 2009;91:830–8CrossRefPubMedGoogle Scholar
  61. 61.
    Spence LD, Savenor A, Nwachuku I, et al. MRI of fractures of the distal radius: comparison with conventional radiographs. Skeletal Radiol. 1998;27:244–9CrossRefPubMedGoogle Scholar
  62. 62.
    Sponsel KH, Palm ET. Carpal tunnel syndrome following Colles’ fracture. Surg Gynecol Obstet. 1965;121:1252–6PubMedGoogle Scholar
  63. 63.
    Stockley I, Harvey IA, Getty CJ. Acute volar compartment syndrome of the forearm secondary to fractures of the distal radius. Injury. 1988;19:101–4CrossRefPubMedGoogle Scholar
  64. 64.
    Trumble TE, Schmitt SR, Vedder NB. Factors affecting functional outcome of displaced intra-articular distal radius fractures. J Hand Surg [Am]. 1994;19:325–40CrossRefGoogle Scholar
  65. 65.
    Varitimidis SE, Basdekis GK, Dailiana ZH, et al. Treatment of intra-articular fractures of the distal radius: fluoroscopic or arthroscopic reduction? J Bone Joint Surg Br. 2008;90:778–85CrossRefPubMedGoogle Scholar
  66. 66.
    Young BT, Rayan GM. Outcome following nonoperative treatment of displaced distal radius fractures in low-demand patients older than 60 years. J Hand Surg [Am]. 2000;25:19–28CrossRefGoogle Scholar

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© Springer-Verlag Berlin Heidelberg 2010

Authors and Affiliations

  1. 1.Department of Orthopaedics and TraumaUniversity of Adelaide, Royal Adelaide and Modbury Public HospitalNorth AdelaideAustralia

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