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Summary

Distal radius fractures are the most frequent lesions encountered

during clinical practice. The treatment is controversial and still debated in

the literature.[1]

The distal end of the radius forms the anatomic foundation of the

wrist joint.[13] The volar surface of the distal radius is relatively flat. It is

covered proximally by the pronator quadratus muscle. The flexor tendons

and the median nerve lay more superficially. The dorsal surface is

convex.[14]

The wrist complex is biaxial joint, with motions of

flexion/extension (volar flexion/dorsiflexion) around a coronal axis, and

radial deviation/ ulnar deviation (abduction/adduction) around an

anteroposterior axis.[29]

Most commonly, injuries occur after a simple fall from standing

height. Almost all distal radius fractures (apart from dorsal rim avulsion

fractures) can be produced by hyperextension of the wrist. Bending forces

tend to occur in low-energy falls and typically produce dorsal

displacement. Shearing forces disrupt the ligamentous connections of the

wrist and produce unstable fracture-dislocations, whilst axial loading,

high-energy injuries compress the articular surface and cause fragments

of joint surface to be impacted.[51, 52]

Various classification systems have been proposed to describe the

injury and help formulate a treatment plan. Broadly they tend to be

anatomical classifications that group fracture patterns, biomechanical that

describe the mechanism of injury and fracture stability or a combination

of both.[51]

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Locking plates have revolutionised treatment for distal radius

fractures. However, proper reduction and technique remain as important

as ever.[71]

The advent of fixed-angle locking plates has improved fracture

healing and addressed the inadequacies of nonlocked plates. Formerly, a

rigid fixation construct with a nonlocked plate was achieved only if there

was minimal motion at the joint or if the bone density was sufficient to

withstand applied physiologic load. In other words, the stability of the

screws in the bone and at the screwplate interface was possible if the

load was kept to a minimum. These are limiting factors that require

prolonged cast immobilization even after surgical fixation. In

osteoporotic bone, minimal axial stress may permit toggling of the screws

and become loose. The locking plate introduced tines at the screw plate

interface creating a single beam construct, which has been reported to

be four times stronger than constructs that allow motion between the

screws and plate.[44]

Conclusion:

Locked plate is ideal for distal radius fractures.

It decreases the potential for toggling of the screws in the cortex.

It permits early range of motion postoperatively, as the construct

can withstand physiologic loading.

Allows the volar approach to be used to treat both volar and dorsal

displaced fractures.

Special value in the management of highly comminuted

metaphyseal and/or osteoporotic fractures in which screws

purchase in the distal fragments might be impossible.