CURRENT CONCEPTS IN ADULTS UPPER EXTREMITY FRACTURES

21452Ugur_TiftikciCurrent_Consept_in_adults.kapak

SURGICAL INTERVENTIONSFOR DISTAL RADIUS AND ULNA FRACTURES

Hamit Çağlayan Kahraman

Fatih Sultan MehmetTraining and Research Hospital, Department of Orthopedics and Traumatology, İstanbul, Türkiye

Kahraman HÇ. Surgical Interventions for 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.287-297.

ABSTRACT

Distal radius and ulna fractures are common injuries that require orthopedic surgical intervention. The treatment of these fractures varies depending on the patient’s demographic characteristics, the severity of the injury, and the specific features of the fracture. Treatment modalities include closed reduction and percutaneous pinning, open reduction and internal fixation, external fixator applications, arthroscopically assisted internal fixation, and temporary wrist arthrodesis. Notably, conservative methods have been shown to provide outcomes equivalent to surgical intervention in patients over 60, thus conservative treatment is generally recommended for elderly patients.

Closed reduction and percutaneous pinning is a less invasive option favored particularly for extra-articular distal metaphyseal or simple intra-articular fractures. This technique is suitable for fractures that cannot be adequately stabilized with casting alone and is associated with long-term positive outcomes such as good range of motion and strong grip strength. Additionally, the intrafocal pinning technique described by Kapandji is less invasive and easier to learn.

External fixators are indicated especially for open fractures and severe intra-articular comminution. This technique is also appropriate for medically unstable patients who cannot tolerate surgical intervention. There are two main types of external fixator applications: non-spanning and spanning fixators. Non-spanning fixators are useful for fractures with large articular fragments, while spanning fixators are preferred for fractures with small articular fragments.

Open reduction and internal fixation is applied especially in fractures showing instability, intra-articular displacements, and specific types of fractures such as volar and dorsal Barton fractures and Die Punch fractures. Volar plating is preferred over dorsal plating to minimize irritation of the extensor tendons. The procedure is performed under fluoroscopic control, ensuring careful placement of the fracture position and screw placement.

Finally, distal ulna fractures often accompany distal radius fractures and must be evaluated for distal radioulnar joint (DRUJ) instability. While ulnar styloid fractures generally do not require fixation, unstable ones can be stabilized with headless screws or cerclage. Treatment options include Kirschner wire fixation, tension band techniques, and open reduction with internal fixation. For very distally located ulna fractures, excision of the fragment and internal fixation are recommended.

Keywords: Radius fractures; Ulna fractures; Colles’ fractures; Fracture fixatation

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