Hand clinics
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There has been a surge in the operative management of distal radius fractures. Closed reduction, external fixation, and open reduction with internal fixation each have advantages and disadvantages. ⋯ Fortunately, the surgeon holds a vast array of options to provide care for patients with distal radius fractures. The choice of fixation or conservative care resides in the personality of the fracture and the needs of the patients.
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In North America, the rate of nonoperative management of displaced distal radius fractures has declined as the rate of internal fixation has increased. Volar locking plate fixation has increased in popularity despite a lack of supportive level 1 evidence. ⋯ Clinicians should be aware of the goals of treatment and challenges, particularly in managing elderly patients with distal radius fractures. Large, randomized controlled trials or meta-analyses may provide answers about when operative intervention is favored over nonoperative management and which operative intervention provides the best outcomes.
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Fractures of the distal radius and ulnar styloid have the potential to disturb the normal function of the distal radioulnar joint (DRUJ), resulting in loss of motion, pain, arthritis, or instability. The DRUJ can be adversely affected by several mechanisms, including intra-articular injury with step-off, shortening, and angulation of an extra-articular fracture; injury to the radioulnar ligaments; ulnar styloid avulsion fracture; and injury of secondary soft tissue stabilizers. This article discusses the management of the DRUJ and ulnar styloid fracture in the presence of a distal radius fracture.