Intra-Articular Injury Associated with Distal Radius Fracture

Gong, Hyun Sik; Bae, Kee Jeong; Baek, Goo Hyun

Abstract

Distal radius fractures are commonly associated with intra-articular injuries such as carpal ligament injuries and triangular fibrocartilage complex (TFCC) injuries. Such injuries occurring in elderly patients with a low-energy distal radius fracture can be treated successfully with cast immobilization and do not usually lead to clinical problems. However, despite healing of the fracture, some intra-articular injuries, especially in active patients with a high-energy fracture, can result in persistent pain and disability. In addition, the current trend of internal fixation and early use of the wrist may actually increase instability due to inadequate healing of the ligament injuries. Due to a lack of typical symptoms and physical findings in acute fracture settings, detection of these injuries is not easy. Arthroscopic examination, as well as radiographs and intraoperative fluoroscopic findings, are useful in detection of carpal ligament injuries. Complete ruptures of intercarpal interosseous ligaments warrant temporary interosseous fixation using K-wires. In TFCC injuries, distal radioulnar joint (DRUJ) instability should be assessed after anatomical reduction and fixation of a distal radius fracture. Operative treatments such as open or arthroscopic repair of TFCC to the fovea can guarantee greater stability of the DRUJ. For optimal results, early detection and appropriate treatment of intra-articular injuries associated with distal radius fractures is critical.