Fractures articulaires du radius distal. pages:167-173
Intra-articular fractures of the distal radius in young patients are often the result of high energy trauma. The damage to the joint is not limited to the bone, but associated cartilaginous and ligamentous damage is frequent. Failure to reduce anatomically the articular surface will lead to posttraumatic osteoarthritis. Incongruity more than 2mm will lead towards degenerative arthritis in almost all cases. Hastings and Leibovic reviewed 50 cases and found poor results in almost all with a step off of more than 2mm and none in those with less than 2mm residual incongruity.
Despite these knowledge the adequate treatment is not always provided. Still the use of plaster casts (sometimes in extreme positions) or external fixation (with excessive traction) are thought to be sufficient to reduce the intra-articular incongruity
Different situation can be seen in daily clinical practice:
- The acute fracture: the patient is seen within 10 days of the accident and he/she can be managed without delay.
- The patient is seen, mainly because of residual pain and limited function, after an initial treatment with persisting incongruity of the articular surface, usually already consolidated, with or without shortening and/or tilting of the distal radial epiphysis.
- The interval between accident and presentation is relatively short and degenerative arthritis is absent.
- The patient is seen much later with an established osteoarthritis due to intra-articular malunion with severe pain, swelling and limited function.