Partial articular, sagittal fracture of the radius, involving the lunate fossa

 

 

Minimally displaced: low-demand patient

Indications

• Minimally displaced fracture
• Low-demand patient

Contraindications

• Displacement
• Associated intercarpal ligament injury

Disadvantages

• Risk of displacement
• Risk of uneven joint surface, leading to early degenerative joint disease
• Sequelae of untreated intercarpal ligament injury

 

 

Temporary stabilization in polytrauma, unfit patient, insufficient hold in a cast, patient not suitable for ORIF

Indications

• Temporary stabilization in polytrauma
• Redisplacement following reduction
• Instability
• Open fracture
• Local soft-tissues compromised for plating

Contraindications

• Poor state of local soft tissues increasing risk of pin track infection
• Patient not fit for surgery

Advantages

• Reduced risk of infection at the fracture site compared to plating
• Lower risk in cases of significant local soft-tissue injury than ORIF
• Straightforward technique

Disadvantages

• Radial sensory nerve injury
• Risk of metacarpal fracture
• Risk of loss of radial length
• Risk of injury to extensor tendon
• Stiffness, especially with over distraction
• Risk of complex regional pain syndrome (type I) (CRPS-I)
• Pin-track infection
• Risk of redisplacement after removal

 

 

Failed or unstable articular reduction

Indications

• Unacceptable displacement
• Failure of less invasive methods
• Instability of distal radioulnar joint
• High-demand patients
• Open fractures
• Intercarpal ligament injury (especially scapholunate diastasis)

Contraindications

• Poor state of local soft tissues
• Patient not fit for surgery
• Severe swelling

Advantages

• Stability of fixation
• Early motion
• Articular congruity with reduced risk of degenerative joint disease

Disadvantages

• Risk of tendon irritation
• More complex implant removal than lag screw
• Possible need for later implant removal