What are the treatment options and what would influence your decision?
- Fracture location, displacement and angulation
- Radial height. Normal = 11mm
- Radial inclination. Normal = 22 degrees
- Articular step off. The joint surface should be congruous.
- Volar tilt. Normal = 11 degrees
1. A simple plaster of Paris can be used if the fracture is in an adequate position. This example is not and needs better reduction.
2. An attempt should always be made to reduce an acute fracture under a local block eg. haematoma block. A backslab should then be applied followed by a plaster of Paris at a later date.
3. Manipulation under anaesthesia is an option if the fracture is significantly displaced. It then needs to be held with a plaster of Paris. Often the distal fragment(s) are held in place onto the proximal bone with K-wires to prevent displacement. The wires can also be used to joystick the fragments back in to position. The wires are usually pulled out in clinic 4-6 weeks later.
4. Open reduction and internal fixation. Volar plating has become increasingly common. It allows accurate reduction of the fracture, rigid internal fixation and early mobilisation (AO principles). There are however higher risks with the surgery and metalwork.
5. External fixation is an option if the fracture is severely comminuted. It may be spanning (across the joint) or bridging (across the fracture only, which has the advantage of allowing joint mobilisation). Again K-wires can help augment the fixation.