No fluff. No fads. Deep-dive investigative reports from the surgeon who actually sees the inside of the joints.
A distal radius fracture is not always a "just cast it" injury. Getting the first ten days right — the imaging, the reduction, the surgical decision — is what separates a wrist that works from a wrist that lingers.
The distal radius is the end of the forearm bone that forms most of the wrist joint. Fall on an outstretched hand — a FOOSH injury — and the impact drives the wrist into extension, fracturing the radius 2–4 cm above the joint. Ice, pavement, skiing, stairs, bikes. It happens to the young on skis and the elderly on floors.
The wrist is a precision joint. A millimeter of residual deformity at the joint surface is the difference between full motion in five years and a patient who can no longer screw the lid off a jar.
Dr. Sameh Elguizaoui, M.D. — Board-Certified Orthopedic Surgeon, Sports Medicine SpecialistTwo X-ray views are not enough. A true evaluation of a distal radius fracture involves measured parameters that predict outcome — and a CT when the joint surface is involved.
A minimally displaced, stable, extra-articular fracture in a patient with modest demand usually heals beautifully in a short-arm cast for six weeks. The question is whether your fracture stays reduced.
Up to 30–40% of closed reductions re-displace in the first two weeks under the cast. That is why every non-op wrist gets imaged at 1 and 2 weeks. If it has slipped, surgery is still on the table — and timing matters.
Open reduction and internal fixation with a volar locking plate has replaced pins and external fixators as the default operation for displaced distal radius fractures. The plate sits on the palm side of the wrist, deep to the tendons, and uses locking screws that grip the thin subchondral bone like a fixed-angle device.
Under fluoroscopy, length, tilt, and inclination are restored. Joint surface is reassembled to within 1 mm.
A low-profile titanium plate is set on the volar cortex. Locking screws into the subchondral bone create a buttress for the reconstructed joint surface.
The plate is stable enough to permit wrist motion within a week. This is the biggest advantage over casting — the tissues stay supple.
No. Volar plates are designed to stay in. Removal is only considered if there is hardware irritation years later, which is uncommon.
With a well-reduced fracture and early motion, most patients regain 90–95% of their pre-injury range. Chronic stiffness usually follows a fracture that was under-reduced or over-casted.
Rarely used today. Volar plating is more rigid, allows earlier motion, and has lower tendon complication rates than dorsal plating or K-wires.
Fixed-angle locking plates grip osteoporotic bone better than compression screws. For elderly patients, we also start bone-health treatment at the fracture visit — the wrist fracture is often the first warning of a future hip fracture.
When fragments extend into the joint surface, when comminution is severe, or when a step-off on X-ray is ambiguous. CT is not routine — but when we need it, we need it.
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