Atlas of the Hand Clinics RSS feed: Current Issue. http://www.handatlas.theclinics.com/?rss=yesElsevier Inc.en © 2006 Published by Elsevier Inc. All rights reserved. Atlas of the Hand Clinics1082-3131112September 2006 © 2006 Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.handatlas.theclinics.com/article/PIIS1082313106000197/abstract?rss=yesTOC10.1016/S1082-3131(06)00019-7Atlas of the Hand Clinics 11, 2 (2006)2006-09-01Atlas of the Hand Clinics2006-09-01112S1082-3131(06)X0010-9vvhttp://www.handatlas.theclinics.com/article/PIIS1082313106000136/abstract?rss=yesThe last few years have seen a radical shift in the treatment of distal radius fractures, from traditional casting and external fixation to open reduction. Dr. Dantuluri has edited an issue that reflects that sea change.ForewordA. Lee Osterman10.1016/j.ahc.2006.10.002Atlas of the Hand Clinics 11, 2 (2006)2006-09-01Atlas of the Hand Clinics2006-09-01112S1082-3131(06)X0010-9viiviihttp://www.handatlas.theclinics.com/article/PIIS1082313106000124/abstract?rss=yesDistal radius fractures are among the most common injuries that occur in the upper extremity and continue to challenge treating physicians in the new millennium. There has been an evolution of treatment as continued advances are made, resulting in a greater understanding of these often complex injuries. Improved biomaterials and implant design have led to differing forms of treatment for these injuries, resulting in the need for a systematic approach in the analysis of these often troublesome fractures. It is our hope that this issue of the Atlas of the Hand Clinics on distal radius fractures will provide a new perspective on these injuries and a better appreciation of these fascinating fractures.PrefacePhani K. Dantuluri10.1016/j.ahc.2006.10.001Atlas of the Hand Clinics 11, 2 (2006)2006-09-01Atlas of the Hand Clinics2006-09-01112S1082-3131(06)X0010-9ixxhttp://www.handatlas.theclinics.com/article/PIIS1082313106000070/abstract?rss=yesEver since the AO/ASIF group established the principles of safe and stable internal fixation for distal radius fractures, this method has evolved continuously, albeit slowly. Despite advances in internal fixation, external fixators continued to play a major role in treatment until studies demonstrated their adverse effects . Early experience with conventional buttress dorsal plating of dorsally displaced distal radius fractures resulted in failure of fixation, particularly in the presence of comminution or poor bone quality. Soft tissue complications such as extensor tendon adherence, inflammation, or occasional rupture often were observed. Gesensway and colleagues were the first to advocate subchondral bone support by designing a fixed-angle dorsal plate for dorsally displaced fractures. Subsequently, AO introduced low-profile dorsal locking plates to prevent loss of reduction, but high rates of implant related problems still were reported . These complications rarely were observed with volarly placed plates, which initially were designed only for volar fracture patterns. Taking advantage of the volar distal radius anatomical features, volar fixed-angle fixation of dorsally displaced distal radius fractures was initiated . The extended flexor carpi radialis (FCR) approach provided the advantages of better visualization of the fracture site, enhanced soft tissue coverage, and adequate blood supply preservation with a low complication rate, while the subchondral support of the articular surface proved to prevent fracture redisplacement of comminuted or osteoporotic distal radius fractures, allowing early rehabilitation. This combination permitted the concurrent restoration of wrist anatomy and function. Moreover, applications were broadened to include complex fractures patterns. This article outlines the advantages and reviews the literature relevant to volar plating for treating distal radius fractures.Volar Plating of Distal Radius FracturesAlejandro Badia, Amel Touhami10.1016/j.ahc.2006.07.001Atlas of the Hand Clinics 11, 2 (2006)2006-09-01Atlas of the Hand Clinics2006-09-01112S1082-3131(06)X0010-9137148http://www.handatlas.theclinics.com/article/PIIS1082313106000021/abstract?rss=yesThe past decade has witnessed a dramatic change in the management of fractures of the distal radius. Despite a lack of many evidence-based studies supporting the efficacy of internal fixation, this has become the preferred method of treatment for all but the most minimally displaced fractures .Fragment-Specific Fixation of Distal Radius Fractures Using the 2.4 mm Synthes Locking System—A Rationale for TreatmentDaniel Rikli, Jesse B. Jupiter10.1016/j.ahc.2006.06.001Atlas of the Hand Clinics 11, 2 (2006)2006-09-01Atlas of the Hand Clinics2006-09-01112S1082-3131(06)X0010-9149161http://www.handatlas.theclinics.com/article/PIIS1082313106000057/abstract?rss=yesDistal radius fractures are not all alike. Differences in the direction and magnitudes of applied force, the position of the hand and forearm at the time of injury, and the underlying quality of bone are important factors that influence the character and extent of injury. Factors such as the degree and extent of articular disruption, association of distal radioulnar joint injury, and type and direction of fracture displacements are some of the parameters that may affect the natural history of the injury and the effectiveness of a specific treatment. Because the term distal radius fracture includes several different groups of injury patterns, no single method of treatment is uniformly effective for every distal radius fracture.Fragment-Specific Fixation of Distal Radius FracturesRobert J. Medoff10.1016/j.ahc.2006.06.004Atlas of the Hand Clinics 11, 2 (2006)2006-09-01Atlas of the Hand Clinics2006-09-01112S1082-3131(06)X0010-9163174http://www.handatlas.theclinics.com/article/PIIS1082313106000033/abstract?rss=yesThere are multiple techniques for treating distal radius fractures. Closed reduction and percutaneous pinning remain a valid and well-accepted method of surgical treatment for displaced and unstable fractures. Pinning has been described for intra and extra-articular fractures and represents a relatively simple, minimally invasive, and cost-effective method of treatment.Closed Reduction and Percutaneous Pinning for Distal Radius FracturesSteven Z. Glickel, Milan M. Patel, Louis W. Catalano10.1016/j.ahc.2006.06.002Atlas of the Hand Clinics 11, 2 (2006)2006-09-01Atlas of the Hand Clinics2006-09-01112S1082-3131(06)X0010-9175185http://www.handatlas.theclinics.com/article/PIIS1082313106000069/abstract?rss=yesFractures of the distal radius are among the most commonly encountered injuries seen in the emergency room setting. Understanding the normal distal radius anatomy is essential for the treating physician. The outcome of management is related directly to successfully identifying, reducing, and stabilizing those unstable fractures. Restoring articular congruity and the relation between the distal radius and the surrounding skeletal structures are key anatomic considerations.Distal Radius Fractures: External Fixation and Supplemental K-WiresKeith B. Raskin, Michael E. Rettig10.1016/j.ahc.2006.06.005Atlas of the Hand Clinics 11, 2 (2006)2006-09-01Atlas of the Hand Clinics2006-09-01112S1082-3131(06)X0010-9187196http://www.handatlas.theclinics.com/article/PIIS1082313106000100/abstract?rss=yesDistal radius fractures are the most common fracture treated by orthopedic surgeons and occur mostly as low-energy extra-articular or minimal articular fractures in middle-aged to elderly women, but with a small peak of incidence also in young men with higher energy injuries, which tend to be intra-articular . Most stable distal radial fractures can be treated in a cast. Metaphyseal instability, defined as demonstrated or predicted inability to retain the reduced radiologic position in a cast, and articular displacement are considered indications for surgical treatment of distal radial fractures in independent patients regardless of age. Numerous surgical techniques are possible in this situation, including nonbridging external fixation, which employs pins in the distal fragment between the fracture and the radiocarpal joint and pins in the radius proximal to the fracture. The fixator does not bridge the radiocarpal, intercarpal, or carpometacarpal joints.Nonbridging External Fixation of the Distal RadiusMargaret M. McQueen, Ingri Ekrol10.1016/j.ahc.2006.08.003Atlas of the Hand Clinics 11, 2 (2006)2006-09-01Atlas of the Hand Clinics2006-09-01112S1082-3131(06)X0010-9197205http://www.handatlas.theclinics.com/article/PIIS1082313106000112/abstract?rss=yesFractures of the distal radius are among the most common injuries affecting the musculoskeletal system. Additionally, they are among the most common fractures treated by orthopedic surgeons, and their incidence is continuing to increase as improving health care has led to increased longevity. There has been an evolution of treatment for these fractures, as cast immobilization and percutaneous pin fixation initially were the mainstays of treatment. The advent of improved biomaterials and implant development, however, has led to an increasing trend toward internal fixation and early mobilization.Intramedullary Fixation of Fractures of the Distal RadiusPhani K. Dantuluri10.1016/j.ahc.2006.09.001Atlas of the Hand Clinics 11, 2 (2006)2006-09-01Atlas of the Hand Clinics2006-09-01112S1082-3131(06)X0010-9207219http://www.handatlas.theclinics.com/article/PIIS1082313106000045/abstract?rss=yesThe radiocarpal and distal radioulnar joints have a low degree of tolerance for residual articular incongruency and malunion following fracture of the distal radius. Articular displacement of only 1 to 2 mm is associated with the development of post-traumatic arthrosis, pain, and wrist stiffness . Radial shortening, dorsal angulation, and residual subluxation of the distal radioulnar joint results in an ulnar positive variance , restricted forearm rotation , altered tendon excursion , and carpal bone kinematics , an increase in load across the radioulnar joint , and decreased grip strength . Management of distal radius fractures may be complicated further by concomitant fracture and/or ligamentous injury about the carpus . Patient factors (eg, age, activity level, and physical demand) and inherent fracture characteristics (eg, degree of stability, comminution, and displacement) affect the proposed treatment algorithm. Operative treatment of distal radius fractures should be considered when acceptable anatomic reduction cannot be obtained and maintained by closed methods.Considerations in Dorsal Plating of Distal Radius FracturesThomas E. Dudley, Matthew D. Putnam10.1016/j.ahc.2006.06.003Atlas of the Hand Clinics 11, 2 (2006)2006-09-01Atlas of the Hand Clinics2006-09-01112S1082-3131(06)X0010-9221230http://www.handatlas.theclinics.com/article/PIIS1082313106000094/abstract?rss=yesWrist arthroscopy has become a valuable adjunct in the treatment of a unique subset of distal radial fractures. Comminuted fractures involving the distal radial articular surface frequently result from high-energy impact injuries. These fractures have an inherent tendency to shorten and collapse and are less amenable to closed manipulation and casting. Arthroscopic assistance in the management of these fractures provides an ideal view of the distal radial joint surface allowing precise internal reduction of fracture segments. This has been referred to as arthroscopic-assisted reduction/internal fixation (ARIF). In addition, arthroscopic assistance allows identification and removal of foreign bodies in the radiocarpal joint and assessment and treatment of the frequently associated soft tissue injuries.Arthroscopy in the Treatment of Distal Radial Fractures with Assessment and Treatment of Associated InjuriesA. Lee Osterman, Scott T. VanDuzer10.1016/j.ahc.2006.08.002Atlas of the Hand Clinics 11, 2 (2006)2006-09-01Atlas of the Hand Clinics2006-09-01112S1082-3131(06)X0010-9231241http://www.handatlas.theclinics.com/article/PIIS1082313106000082/abstract?rss=yesFractures of the distal radius are common injuries seen by the orthopaedic surgeon. The average life expectancy of the population of the United States has increased steadily over the past few decades. There has been a corresponding increase in the incidence of distal radius fragility fractures . Restoration of the normal anatomy, fracture stability, fracture union, and restoration of function are the primary goals of the treating orthopaedic surgeon. Trends in distal radius fracture treatment focus on achieving those specific objectives using less invasive techniques in a shorter amount of time. Rigid fixation of distal radius fractures has been discussed elsewhere in this issue and has revolutionized the treatment of these fractures. Rigid fixation has allowed for earlier stability of the fracture and earlier mobilization and return to activity.Bone Grafts and Bone Graft Substitutes in Distal Radius FracturesJeffrey Yao, Amy L. Ladd10.1016/j.ahc.2006.08.001Atlas of the Hand Clinics 11, 2 (2006)2006-09-01Atlas of the Hand Clinics2006-09-01112S1082-3131(06)X0010-9243250