Minimally invasive reduction and osteosynthesis of articular fractures of the distal radius.

Treatment of displaced fractures of the distal radius has changed over the course of time. For many years, closed reduction with plaster immobilization was considered the treatment of choice. Subsequent use of pins and plaster, percutaneous pin fixation, and the development of external fixation devices all contributed to improving fracture stability. More recently a new generation of external fixation devices has been developed to permit distraction and palmar translation. In addition, over the past twenty years, we have seen the development of more sophisticated internal fixation devices for the treatment of displaced fractures of the distal radius. The indications for open reduction and internal fixation have been defined largely on the basis of numerous studies which support the concept that articular malreduction is predictive of traumatic arthritis and poor functional result. Knirk and Jupiter have reported poor results for intra-articular fractures of the distal radius having an articular step-off greater than 2 mm. More recently, wrist arthroscopy has been used to improve visualization of articular surfaces and aid fracture reduction. In addition, bone grafting techniques have been employed more frequently to accelerate fracture healing. With improvement in techniques, we are able to provide our patients with better functional results and return them to their activities of daily living and vocation more rapidly.