CURRENT CONCEPTS IN ADULTS UPPER EXTREMITY FRACTURES

21452Ugur_TiftikciCurrent_Consept_in_adults.kapak

CONSERVATIVE MANAGEMENTOF DISTAL RADIUS AND ULNA FRACTURES

Yusuf Polat

Ordu University, Faculty of Medicine, Department of Orthopedics and Traumatology, Ordu, Türkiye

Polat Y. Conservative Management of Distal Radius and Ulna Fractures. In: Tiftikçi U, Erdoğan E, Ergün C, Güneş Z, editors. Current Concepts in Adults Upper Extremity Fractures. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.279-286.

ABSTRACT

Distal radius fractures are primarily observed in young males due to high-energy trauma and, to a greater extent, in elderly osteoporotic women following low-energy injuries. Particularly in geriatric patients, while surgical treatment may show better radiological results, no significant differences in functional outcomes have been observed. Categorizing patients into lowand high-expectation groups can help determine the treatment option for distal radius fractures in elderly patients.

The primary goal of conservative treatment is to ensure proper fracture healing by stabilizing the fracture after a successful closed reduction, followed by immobilization with a cast. Closed reduction involves repositioning displaced bone fragments into the correct alignment using various maneuvers while the arm is under traction. After reduction is achieved, the wrist is immobilized in palmar flexion and ulnar deviation with a cast. This position ensures sufficient tension in the dorsal compartment tendons and ligaments, maintaining the reduction through the principle of ligamentotaxis.

The criteria used to determine the adequacy of reduction are based on anatomical parameters from X-ray films. However, these indices should generally be applied to active patients who engage in activities requiring strength in their wrists. In addition to radiological parameters, factors such as the patient’s age, bone quality, lifestyle, occupation, and the condition of soft tissues are also evaluated when making treatment decisions. The American Academy of Orthopedic Surgeons (AAOS) recommends conservative treatment for fractures where radial shortening is less than 3 mm, dorsal tilt is less than 10°, and intra-articular step-off is less than 2 mm. Additionally, in patients aged 55 and over, evidence suggests no significant difference between cast and surgical fixation.

Management of isolated distal ulna fractures may seem straightforward but can vary significantly. Fractures with up to 50% cortical involvement can be treated conservatively with immobilization using a long arm cast. Ulnar styloid fractures are typically treated with immobilization alone. By immobilizing the forearm in supination, stability of the distal radioulnar joint (DRUJ) is maintained, helping to prevent late instability.

Following the initial trauma the early increase in swelling and inflammation raises the pressure within the carpal tunnel, making elevation crucial. Care should be taken to avoid excessive flexion at the elbow to prevent compromising circulation and overstretching the ulnar nerve.

Conservative treatment for distal radius and ulna fractures is an effective option when appropriately applied. The management of these fractures involves closed reduction, immobilization, and rehabilitation.

Keywords: Conservative treatment; Closed fracture reduction; Radius fractures; Ulna fractures

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