Treatment of Comminuted Impacted Intraarticular Distal Radius Fracture

Assessment and Classification

Intraarticular fractures with displacement require careful evaluation of the degree of displacement, joint congruity, and stability to determine the optimal treatment approach 1
CT scanning is an option to improve diagnostic accuracy for these fractures 2
Fractures are classified as significantly displaced when there is >3mm displacement or >10° dorsal tilt 1

The American Academy of Orthopaedic Surgeons recommends volar locked plating as the primary treatment option for comminuted intraarticular fractures, providing earlier functional return and better functional outcomes compared to conservative management 3
Volar locked plating leads to better functional outcomes compared to conservative management, with earlier wrist mobilization, better range of movement, less pain and disability, and early return of function 3
Arthroscopic-assisted reduction is an option for improved diagnostic accuracy and treatment of intraarticular fractures, allowing for evaluation and treatment of associated ligament injuries 2

Bone grafting may be necessary for severely comminuted fractures with bone voids, though evidence is inconclusive regarding outcomes 2
Arthroscopic evaluation of associated ligament injuries at the time of radius fixation is an option 2

Active finger motion exercises should be performed following surgery to prevent stiffness 3
Radiographic follow-up is recommended at approximately 3 weeks and at the time of immobilization removal 3
Early wrist motion is not routinely necessary following stable fracture fixation 4

Conservative management is not typically recommended for comminuted intraarticular fractures due to risk of joint incongruity and subsequent arthritis 1

Volar locked plating for comminuted intra‑articular distal radius fractures yields superior short‑term functional recovery compared with dorsal plating, external fixation, or percutaneous pinning, with patients typically regaining functional use of the wrist by approximately three months post‑operatively. (American Academy of Orthopaedic Surgeons) 5

The AAOS guideline states that routine arthroscopic‑assisted reduction is not recommended; moderate‑quality evidence shows that fluoroscopic guidance alone provides equivalent functional outcomes at 48 months, making arthroscopy optional only for specific cases such as associated ligamentous injury assessment. (American Academy of Orthopaedic Surgeons) 6