Page 96 - Hospital Authority Convention 2017

Masterclasses
HOSPITAL AUTHORITY CONVENTION 2017

M3.3 Recent Advances in Management of Distal Radius Fracture 13:15 Room 423 & 424

Outcome with Advanced Technique of Fracture Fixation
Wong HK
Department of Orthopaedics and Traumatology, Princess Margaret Hospital, Hong Kong
Distal radius fractures are common injuries. They can be treated with conservative treatment or operative treatment.
Conservative treatment for unstable fractures, displaced intra-articular fractures and fractures irreducible by closed reduction
will give rise to poor outcome. Computed tomography is useful in assessing the configuration of intra-articular fractures.

Open reduction or arthroscopic assisted reduction and internal fixation can allow accurate reduction of the displaced intra-
articular fractures. Internal fixation with angular stable locking plates after restoring the normal anatomy can allow immediate
post-operative mobilisation to minimise wrist joint stiffness. There are many different designs of regional specific implants
available in the market.

Volar plating is the treatment of choice in most fracture types. It can provide better soft-tissue coverage and less tendon
irritation.

Open reduction and dorsal plating may be required in some cases when a volar approach alone cannot achieve anatomical
articular reduction and stable fixation. It is technically more demanding and requires careful and well planned soft tissue
handling.
Tuesday, 16 May

M3.4 Recent Advances in Management of Distal Radius Fracture 13:15 Room 423 & 424

Soft Tissue Complication Associated with Distal Radius Fracture
Yau E
Hand and Microvascular Service, Department of Orthopaedics and Traumatology, Queen Elizabeth Hospital, Hong Kong

Closed reduction and plaster cast immobilisation remain the mainstay of treatment of stable distal radius fractures. For
unstable injuries, surgical intervention is indicated. Advancement in surgical techniques and fixation devices over the past
decades has enabled surgical fixation stable enough for early mobilisation of the wrist, which in turn hastens recovery. A
lot of previously unrecognised soft tissue injuries left to heal through immobilisation were brought to light therefore. More
rigorous assessment of outcome of this common fracture also contributes to the recognition of these pathologies. The more
common soft tissue complications include triangular fibrocartilage complex (TFCC) tear, carpal interosseous ligament injury
and median nerve compromise.

TFCC injury occurs in 40% to 70% of intra-articular fractures of distal radius in young patients. Left untreated, symptomatic
distal radioulnar joint instability with chronic ulnar pain can develop. Carpal interosseous ligament injury, scapholunate and
lunotriquetral ligaments in particular, can cause carpal malalignment. Pain and early osteoarthritis of the wrist can develop
in malaligned carpus. These injuries can be diagnosed by careful pre-operative clinical and radiological assessments.
Arthroscopic assessment of the wrist at the time of fracture fixation allows accurate diagnosis of these conditions. The
development of “dry arthroscopy” decreases the risk of compartment syndrome associated with traditional arthroscopic
technique requiring fluid insufflation of the joint.
Median nerve dysfunction can result from nerve compression by soft tissue swelling or haematoma, or contusion of the nerve
diminishing its function masking the evolving compartment syndrome in the carpal canal. The latter mechanism has led to the
practice of prophylactic carpal tunnel release by some surgeons in cases of high energy trauma.
Treating distal radius fractures, therefore, does not only involve bony fixation. Satisfactory outcome can only be obtained
when associated soft tissue injuries are addressed.

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