Percutaneous and limited open reduction of intra-articular distal radial fractures.

Fluoroscopy monitors intra-articular distal radial fracture reduction and stabilisation. The reduction is guided by traction, ligamentotaxis and manipulation, and when necessary, completed by minimally invasive percutaneous or limited open instrumentation. Kirschner wires effectively splint the reduction until fracture callus is visualised on X-ray. An occasional mini plate is required to buttress a displaced volar medial lunate facet (die punch) fragment into position. First, major metaphyseal articular fragments are approximated to restore the articular surface. Smaller fragments follow their larger counterparts into position or may be ignored (the "Rule of the Majority" or "Vassal Rule"). The repaired metaphysis is then aligned with and stabilised to the diaphysis. Cancellous bone may be inserted through small targeted incisions when defects and areas of comminution are present. The wrist is splinted in a functional (slightly extended) position for three to four weeks in uncomplicated cases. Digital elevation and rehabilitation are emphasised during the early stages of fracture healing. After callus appears on X-ray, progressive wrist rehabilitation is initiated and the patients are weaned from their splints. Minimally invasive surgical intervention, good pain control and early rehabilitation maximise functional recovery and minimise morbidity, medical costs and lost work time.