Management of distal radius fractures.

T he discovery of the x-ray was 80 years away when Irish surgeon Abraham Colles published his paper about fractures of the "distal extremity of the radius." He had no idea about the possible intra-articular component of this fracture, but he knew that the fracture was unstable and frequently settled back to the deformity that "will remain undiminished through life."l The management of this very common fracture and its dysfunctional sequelae2-13 has remained a challenge to surgeons and therapists alike. Improved treatment with better functional results and fewer complications for unstable, intra-articular, displaced, and comminuted distal radius fractures has been more vigorously pursued by modern orthopedic surgeons and hand surgeons. The more recent literature tends to support a definite correlation between accurate anatomic position and a more positive functional outcome.14-26 Heightened awareness of risk factors for instability, shortening, and malunion, coupled with better methods of fixation, has improved functional results.27-35 The references to therapy following distal radius fraCtures in the literature are mixed. In some sources, there is no mention of therapy.2A,3o,32,36-39 Other sources state that therapy is recommended only if finger and wrist stiffness persist,8,20,40-42 and that the need for therapy may actually be considered to be a poor prognostic sign. More contemporary sources stress the importance of therapy and rehabilitation following fracture management with external fixation or open reduction and internal fixation (ORIF). Typically, however, these references are brief and general, and provide few specifics about the therapeutic management.14,16,18.26.28.32.33,43,44-49 Most hand surgeons and hand therapists agree that therapy does play an important role in the treatment of these fractures, and therapist-authored chapters have outlined treatment techniques.50,51 However, there is no study to document the effectiveness of rehabilitation and what impact therapy may have on the final outcomes. The treatment goals for any distal radius fracture are anatomic reduction, restoration of joint congruency, and upper-extremity function with maximum pain-free wrist and forearm range of motion