What is the treatment for an intraarticular fracture of the radius?

Treatment of Intraarticular Fractures of the Radius

Surgical fixation is recommended for intraarticular fractures of the radius with postreduction radial shortening >3 mm, dorsal tilt >10°, or any intraarticular displacement. 1, 2

Assessment and Classification

• Intraarticular fractures of the radius should be evaluated for displacement (>3mm), dorsal tilt (>10°), and articular congruity to determine appropriate treatment 2
• Radiographic evaluation is essential to confirm diagnosis, fracture pattern, and guide treatment decisions 2

Treatment Algorithm

Conservative Management

• Conservative treatment with removable splints is appropriate ONLY for minimally displaced intraarticular fractures 3, 4
• For stable, minimally displaced fractures:
  • Immobilization typically lasts 3-4 weeks 3, 2
  • Radiographic follow-up at approximately 3 weeks and at immobilization removal to confirm adequate healing 3
  • Active finger motion exercises should be performed following diagnosis to prevent stiffness 3, 2

Surgical Management

• Surgical fixation is indicated for:

  • Postreduction radial shortening >3 mm 1, 2
  • Dorsal tilt >10° 1, 2
  • Any intraarticular displacement 1, 2
  • Fractures that fail closed reduction 5, 6

• Surgical options include:

  • Open reduction and internal fixation (ORIF) with plates (commonly T-plates) 5, 6
  • Arthroscopic-assisted reduction for better visualization of the articular surface 4

Outcomes Based on Fracture Pattern

• Best surgical outcomes are seen in:

  • Minimally comminuted fractures with three or fewer articular fragments 7
  • Fractures where articular congruity can be restored 8, 9

• Poorer outcomes are associated with:

  • Comminuted fractures with more than three fragments 7
  • Associated fracture-dislocations of the elbow or forearm 7
  • Inability to restore articular congruity 8, 9

Potential Complications

• Stiffness is one of the most functionally disabling adverse effects of distal radius fractures 3
• Other complications may include:
  • Tendon rupture 6
  • Nerve paresthesias 6
  • Wound infections 6
  • Compartment syndrome 6
  • Immobilization-related adverse events (skin irritation, muscle atrophy) in approximately 14.7% of cases 2

Prognostic Factors

• The number of fracture fragments correlates most closely with functional outcome 8
• Restoration of articular congruity, reduction of gap between fragments, and correction of radial shortening strongly correlate with improved outcomes 8
• When intra-articular step-off exceeds 2 mm or the radius is shortened more than 5 mm, results are typically only fair and posttraumatic arthritis is more likely 9

Follow-up Protocol

• Radiographic evaluation should be performed:
  • Initially to confirm diagnosis and fracture pattern 2
  • At approximately 3 weeks post-treatment to assess healing 3, 2
  • At the time of immobilization removal to confirm adequate healing 3, 2