Treatment of Intraarticular Radial Fractures
For intraarticular radial fractures, volar locked plate fixation is recommended as the primary treatment option as it leads to better functional outcomes compared to conservative management, with earlier recovery of function in the short term. 1
Surgical Management Options
- Volar locked plating is the preferred surgical technique for intraarticular radial fractures, providing earlier functional return in the short term (first 3 months) compared to other fixation methods 1
- Other surgical options include dorsal plating, external fixation, and percutaneous fixation with Kirschner wires, but evidence shows no significant difference in long-term outcomes between these techniques 1
- Arthroscopically-assisted reduction may be beneficial for visualizing and addressing the articular surface, particularly when there are associated ligament injuries 2
Indications for Surgical Management
- Surgical fixation is indicated for fractures with:
- Significant displacement (>3mm)
- Dorsal tilt >10°
- Intraarticular involvement with displacement 3
- Studies show that adult patients with acceptably reduced intra-articular distal radial fractures have better functional outcomes for 12 months when treated operatively versus nonoperatively 4
Postoperative Management
- Early mobilization following surgical fixation is recommended to prevent stiffness and improve functional outcomes 5
- Patients who undergo early mobilization after volar plate fixation show:
- Better range of motion in the sagittal plane
- Improved grip strength up to 6 months
- Better functional scores compared to immobilization 5
- Active finger motion exercises should be performed following surgery to prevent stiffness, which is one of the most functionally disabling adverse effects 3
Radiographic Follow-up
- The American Academy of Orthopaedic Surgeons (AAOS) guidelines indicate that no difference exists in outcomes based on frequency of radiographic evaluation 1
- However, radiographic follow-up is typically recommended at approximately 3 weeks and at the time of immobilization removal to confirm adequate healing 3
Pain Management Considerations
- Multimodal and opioid-sparing protocols should be considered when possible 1
- Non-opioid alternatives include:
- Local anesthetics
- Nonsteroidal anti-inflammatory agents
- Acetaminophen
- Non-pharmacologic interventions (ice, elevation, compression) 1
Potential Complications
- Secondary loss of reduction occurs in approximately 25% of patients treated conservatively with casting 6
- Persistent pain is significantly related to the size of articular step-off; anatomical reduction with step-off <1mm is recommended 7
- Immobilization-related adverse events occur in approximately 14.7% of cases and may include skin irritation and muscle atrophy 3
Clinical Outcomes
- Elderly patients with intra-articular distal radius fractures treated with volar plating show significantly better functional outcomes and quality of life compared to conservative treatment 6
- Restoration of the articular surface, radial inclination, and ulnar variance significantly affects outcomes 6
- At one year post-surgery, early mobilization after volar plating can achieve 93% "excellent" and "good" results according to functional scoring systems 5