Skip to content

Wrist Fractures and Dislocations

Distal radius fractures and wrist dislocations: management of low-energy vs high-energy injuries and indications for volar plating.

Overview

Ulnar to radial dorsal wrist fracture-dislocations involve dorsal dislocation with presumed ulnar-to-radial injury progression and relative sparing of radial structures [1]. Optimal outcomes in forearm fracture-dislocations depend on early recognition and management, with restoration and maintenance of anatomic alignment serving as key principles [2]. For distal radial fractures, nonoperative management of completely displaced injuries in appropriately selected cases yields excellent outcomes without exposing the child to surgical risks [4]. Most ulnar-sided wrist problems associated with distal radial fractures can be treated non-operatively initially, typically for over a year, in anticipation of substantial improvement with time [3].

In adults, operative management of acceptably reduced intra-articular distal radial fractures results in better functional outcomes for 12 months compared to nonoperative treatment [25]. However, operative management in adults under 65 years of age leads to significantly fewer secondary procedures at the expense of increased overall 1-year complication rates, specifically stiffness [83]. For distal radius fractures that were initially nondisplaced or minimally displaced, the overall rate of unacceptable radiographic displacement at 6 weeks is 30% [23]. Good and equivalent functional and subjective outcomes are achieved with both fragment-specific wrist fixation and volar locking plate fixation in primary and secondarily dislocated distal radius fractures [26].

The indication for using intramedullary nail fixation should continue to be limited to extra-articular and simple intra-articular distal radius fractures until additional data can be obtained [21]. Utilization of a new fixation device for distal radius fractures with displaced dorsal lunate facet fragments demonstrates satisfactory clinical and radiographic results and minimal complications [79]. There is a lack of objective evidence on long-term outcomes for the unstable wrist, highlighting the need for collaborative working and referral to specialized centers to run randomized controlled trials [7]. Due to the rarity of displaced fractures, only multicenter studies extending over long periods of time will lead to accurate definition of the results and prognoses associated with operatively treated fractures [11].

Anatomy & Pathophysiology

Osseous

Fractures of the dorsal articular margin of the distal radius are associated with dorsal radiocarpal subluxation [6]. Site-specific differences in the acoustic properties of distal radial cartilage exist in living human wrist cartilage [46].

Ligamentous

The forearm’s bony and soft tissue structures function together as a single unit [42]. Disruption of more than one bony or soft tissue structure in the forearm results in forearm instability [42]. The scapholunate interosseous ligament (SLIL) generates proprioceptive stimuli at every wrist position [52]. Triquetral impingement ligament tear (TILT) involves a ligament tear that, when repaired, results in improved wrist motion and strength [36].

Meniscal

Distal radioulnar joint instability in distal radius fractures involves the sigmoid notch and triangular fibrocartilage complex (TFCC) [39]. Radiostereometry can be used to precisely quantify distal radioulnar joint stability after different grades of triangular fibrocartilage complex injury [51].

Kinematics

Ulnar variance changes with the application of load and position of the wrist during full-body weight-bearing [33]. Wrist position influences metacarpophalangeal joint motion of the index through small fingers [32]. Wrist position influences extensor pollicis brevis (EPB) tendon excursion in healthy people [44]. Active magnetic resonance imaging (MRI) may be useful in the investigation of dynamic wrist instability in vivo [15].

Classification

Dorsal Fracture-Dislocation Pattern: Ulnar to radial dorsal fracture-dislocations of the wrist are characterized by dorsal dislocation and presumed ulnar to radial progression of injury with relative sparing of radial structures [1]. These injuries are complex, requiring detailed surgical planning [16]. Optimal outcomes depend on early recognition and management, with restoration and maintenance of anatomic alignment being the key principles [2]. Satisfactory wrist function can be achieved with operative treatment in most patients despite the relative complexity of dorsal articular margin fractures of the distal radius with dorsal radiocarpal subluxation [6].

AO Classification: The AO classification system provided only fair to moderate reliability when applied to radiographs of patients requiring fixation of a fracture of the distal radius, suggesting that in its current form, this system is inadequate for clinical and academic use [54].

DREAD Classification: The DREAD classification organizes and describes articular fragment escape patterns following distal radius fracture fixation to raise awareness and facilitate decision-making [57].

Melone Classification: The Melone classification system is not suitable for characterizing all C3 fractures [85].

Intermediate Column Classification: A new classification for intermediate column fractures of the distal radius reflects the characteristics of these fractures and may provide an important reference for choosing treatment and evaluating prognosis [86].

Palmar Ulnar Corner Fragment Morphology: Three morphological types of palmar ulnar corner fragments in distal radial fractures have emerged, and understanding this morphology may guide optimal reduction and fixation strategy to prevent palmar radiocarpal subluxation, especially in type 3 fractures [88].

Other Considerations: Incorporating fracture tagging holds promise for future advancements in 3-D classifications of fractures of the distal radius [63]. Findings support the need for a higher index of suspicion for scapholunate dissociation in distal radial fracture subtypes associated with two-part articular fractures [70]. The ligamentous attachments of the distal radius to the volar carpus are relatively well preserved in intra-articular distal radius fractures [89]. Intraoperative C-arm CT imaging allows for the secure identification of malpositioned screws and immediate correction, particularly in complex radius fractures [91]. Consensus on defining abnormal wrist motion and the development of a measurement device for wrist translation are needed [13]. Results from wrist scoring systems should be interpreted with caution [14].

Clinical Presentation

History and Mechanism

Ulnar to radial dorsal wrist fracture-dislocations are characterized by dorsal dislocation and presumed ulnar to radial progression of injury with relative sparing of radial structures [1]. Distal radioulnar joint instability in adolescents is often preceded by fracture of the distal radius and is often not an isolated pathoanatomical problem [8].

Inspection and Palpation

Tenderness of the distal radial metaphysis after wrist injury is strongly suggestive of a distal radius fracture despite both normal plain radiographs and fluoroscopic images [18]. Isolated fractures of the ulnopalmar rim of the distal radius cause radiocarpal joint instability and merit particular attention [22].

Stability and Special Tests

Acute distal radioulnar joint instability is primarily a clinical diagnosis, and physical examination remains a mainstay of diagnosis [34]. Partial or complete tears of the ligaments of the wrist that are not detectable on standard radiographs may be the reason that some patients continue to have symptoms despite an anatomically healed fracture [20].

Red-Flag Patterns

Dorsal fracture-dislocations of the radiocarpal joint are complex injuries requiring detailed surgical planning [16]. Co-existing subluxation or dislocation of the other radioulnar articulation must not be overlooked in cases of fracture dislocation of one radioulnar joint [43]. Early, accurate diagnosis of fourth and fifth CMC joint fracture-dislocations is crucial for optimizing hand function and postoperative outcomes [37]. Prompt recognition and treatment are imperative for perilunate dislocations and fracture-dislocations [45]. Early diagnosis and management lead to an improved prognosis for isolated scaphoid dislocation [12]. Clinical results for PIP joint dislocations and fracture-dislocations vary and are often difficult to predict due to the complexity of fracture patterns and potential for sub-acute or chronic presentation [35].

Investigations

Plain radiography: Standard radiographs remain the routine initial diagnostic modality for wrist injuries [93]. However, tenderness of the distal radial metaphysis after wrist injury is strongly suggestive of a distal radius fracture despite both normal plain radiographs and fluoroscopic images [18]. The initial radiograph of a distal radius fracture does not predict a triangular fibrocartilage complex injury [100]. Isolated fractures of the ulnopalmar rim of the distal radius cause radiocarpal joint instability and merit particular attention [22]. Trapezoid fractures may be underdiagnosed, and computed tomography is recommended over plain radiography alone in case of clinical suspicion [94].

MRI: Early diagnosis and management lead to an improved prognosis for isolated scaphoid dislocation [12]. Active-MRI may be useful in the investigation of dynamic wrist instability in vivo [15]. Magnetic resonance imaging using advanced multiparametric sequences may facilitate accurate, noninvasive assessment of articular cartilage changes after distal radius fracture without the need for a contrast agent [73]. Acute ischaemia of the scaphoid is rare in the absence of fracture but may be more frequently detected by wrist MRI in children, especially in those presenting with significant wrist trauma and normal radiographs [77]. The use of early MRI in patients with clinically suspected scaphoid fracture results in the accurate and reliable identification of a significant number of radiological occult injuries and early identification of patients without acute injuries [81]. MRI may be more helpful to exclude potential alternative diagnoses in the patient with ulnar wrist pain [97]. There is a need for a consensus definition of scaphoid fractures on MRI scans to assess the reliability and diagnostic performance of MRI scans for diagnosing true scaphoid fractures, as well as their potential harms and benefits [98].

CT: All perilunate fracture-dislocations deserve additional imaging (CT or MRI) to assess alignment and hardware placement [90]. Computed tomography is recommended over plain radiography alone in case of clinical suspicion for trapezoid fractures [94]. CBCT is a powerful imaging modality for evaluating wrist injuries; however, standard radiographs of the wrist should remain the routine initial diagnostic modality [93].

Ultrasound: Ultrasound imaging may be useful in cases where intra-articular and/or comminuted fractures require distal plate placement and engagement of screws in the dorsal cortex [92].

Other Considerations: Ulnar to radial dorsal wrist fracture-dislocations are characterized by dorsal dislocation and presumed ulnar to radial progression of injury with relative sparing of radial structures [1]. Distal radioulnar joint instability in adolescents is often preceded by fracture of the distal radius and is often not an isolated pathoanatomical problem [8]. Patients with radiographic carpal collapse and ulnar translocation following scaphocapitate arthrodesis for Kienböck disease may remain asymptomatic [17]. Clinical and radiological results of early and delayed surgery after loss of reduction in secondary displaced distal radius fractures are similar [5]. Delayed diagnosis of carpometacarpal fracture-dislocations makes closed reduction difficult and was associated with less favorable radiographic outcome [99]. All fractures achieved radiographic union at a mean of 9 weeks with no complications observed in robot-assisted percutaneous scaphoid fixation [96].

Treatment

Non-Operative Management

Nonoperative management remains the most common treatment for distal radius fractures, though significant functional deficiencies correlate with poor reductions [76]. For elderly patients (aged 65 years and older) with displaced distal radius fractures, cast immobilization is non-inferior to volar locking plates regarding QuickDASH scores at one year [75]; consequently, non-operative treatment should be seriously considered for older patients with redisplaced fractures [56]. Similarly, distal ulna fractures associated with distal radius fractures in patients 65 years and older can be successfully managed nonoperatively [64]. In pediatric cases, nonoperative management of completely displaced distal radial fractures in appropriately selected patients results in excellent outcomes without exposing the child to surgical risks [4]. For Salter-Harris II distal radius fractures, no specific recommendations define an acceptable reduction or identify which fractures benefit from surgical intervention [71].

Routine primary nonoperative management of isolated stable radial head fractures provides satisfactory outcomes for the majority of patients, with few requiring further intervention for persisting complaints [27]. Most ulnar-sided wrist problems associated with distal radial fractures can be treated non-operatively initially, typically for over a year, in anticipation of substantial improvement with time [3]. However, nonoperative management of forearm fracture–dislocations is associated with high rates of unsatisfactory results; anatomic reduction and rigid internal fixation are required [80].

For distal radius fractures that were initially nondisplaced or minimally displaced, the overall rate of unacceptable radiographic displacement at 6 weeks was 30% [23]. Surgeons should have a low threshold for operative treatment in patients with dislocated distal radial fractures, particularly in younger and working-age groups, and radiographic control is mandatory 10–14 days after initial non-operative treatment to identify marginal secondary displacement [72]. Immobilization in a cast for four weeks is safe and yields results similar to six weeks of immobilization in adult patients with a displaced and adequately reduced distal radial fracture [62]. Mobilisation 10 days after reduction cannot be recommended for the routine treatment of reduced distal radius fractures [82].

Operative Management

Indications: Adult patients with an acceptably reduced intra-articular distal radial fracture have better functional outcomes for 12 months when treated operatively instead of nonoperatively [25]. Good and equivalent functional and subjective outcomes were found for both fragment-specific wrist fixation and volar locking plate fixation in primary and secondarily dislocated distal radius fractures [26]. Three years after surgery for unstable dorsally displaced distal radius fractures, clinical and radiological results for volar locking plates (VLP) and external fixation (EF) were comparable [65]. Treatment of unstable distal radius fractures with a VLP is associated with few major complications [49]. Pinning is an efficacious, low-cost treatment option for 2- and 3-part distal radius fractures with excellent long-term results [61]. The indication for using intramedullary nails should continue to be limited to extra-articular and simple intra-articular distal radius fractures until additional data can be obtained [21]. A good functional long-term outcome can be expected after operative and non-operative treatment of radial neck fractures in adults [10]. Arthroplasty should be used as an alternative to arthrodesis in the treatment of posttraumatic wrist arthritis, given proper patient selection and indications [74].

General Principles and Surgical Technique: Optimal outcomes in the treatment of forearm fracture–dislocations depend on early recognition and management, with restoration and maintenance of anatomic alignment being the key principles [2]. The goal of treatment for Galeazzi fractures and dislocations is anatomic reduction and rigid internal fixation of the radial fracture along with restoration of normal distal radioulnar joint anatomy [80]. Surgeons should retain a flexible approach to treatment choice and master non-operative management, as well as both external and internal skeletal fixation techniques, due to the complexity of distal radial fractures [78].

Postoperative Care and Rehabilitation

Early mobilization after surgical treatment of distal radius fractures does not lead to improved patient-reported outcome [60]. Self-efficacy corresponds to wrist function after combined plating of distal radius fractures [58].

Complications

Instability: Distal radioulnar joint (DRUJ) instability in adolescents often follows distal radial fracture and is rarely an isolated pathoanatomical problem [8]. Subacute DRUJ subluxation may occur early, typically under 2 weeks post-injury, and is easily overlooked [28]. Ulnar to radial dorsal wrist fracture-dislocations involve dorsal dislocation with presumed ulnar-to-radial injury progression and relative sparing of radial structures [1]. Nonsurgical management of perilunate fracture-dislocations results in progressive arthritis and poor long-term outcomes [29].

Malunion and Deformity: Late displacement occurs in 28% of cases, associated with loss of grip strength and range of motion, though no significant differences appear in outcome questionnaires [31]. Long-term follow-up of forearm shortening and volar radiocarpal capsulotomy for wrist flexion deformity in children with amyoplasia shows initial positional improvement is not maintained [9]. Long-term outcomes for distal radial fractures are generally good regardless of radiological results, although the likelihood of symptomatic malunion depends on patient factors and overall wrist alignment [24]. Clinical experience and literature do not support the assumption that untreated distal radial fractures lead to symptomatic osteoarthritis [30].

Soft Tissue and Ligamentous Injury: Partial or complete tears of wrist ligaments undetectable on standard radiographs may cause persistent symptoms despite anatomically healed fractures [20]. An associated ulnar styloid fracture results in slower recovery of grip strength and wrist flexion, though no long-term differences in measured impairments are observed [19]. Most ulnar-sided wrist problems associated with distal radial fractures can be treated non-operatively initially, typically for over a year, anticipating substantial improvement with time [3].

Other Considerations: Nonoperative management of completely displaced distal radial fractures in appropriately selected cases yields excellent outcomes without exposing the child to surgical risks [4]. Clinical and radiological results of early versus delayed surgery after loss of reduction in secondary displaced distal radius fractures are similar [5]. A good functional long-term outcome is expected after operative and non-operative treatment of radial neck fractures in adults [10]. Routine primary nonoperative management of isolated stable radial head fractures provides satisfactory outcomes for most patients, with few requiring further intervention [27]. Due to the rarity of displaced glenoid cavity fractures, only long-term multicenter studies will accurately define results and prognoses for operatively treated cases [11]. There is a lack of objective evidence on long-term outcomes for the unstable wrist, highlighting the need for collaborative working and referral to specialized centers for randomized controlled trials [7]. The Scheker Prosthesis (Aptis) Distal Radioulnar Joint Arthroplasty has a moderate persistent complication rate, making accurate radial component placement important [87]. The overall incidence of adult distal forearm fractures is 207.8/100 000/year [95].

Recovery

Light activity (weeks): Early recognition and management are critical for optimal outcomes in forearm fracture-dislocations, with restoration and maintenance of anatomic alignment being key principles [2]. For distal radial fractures, conservative treatment produced an increase in upper limb disability after 1 year of follow-up [66]. In the working-age population, operative treatment of distal radius fracture led more often to longer time lost from work than conservative treatment [101].

Full activity (months): Most ulnar-sided wrist problems associated with distal radial fractures can be treated non-operatively initially, typically for over a year, in anticipation of substantial improvement with time [3]. Nonsurgical management of perilunate fracture-dislocations results in progressive arthritis and poor long-term outcomes [29]. Late displacement in distal radius fractures occurred in 28% of cases and was associated with loss of grip strength and range of motion, but no significant differences were seen in outcome questionnaires [31].

Complete recovery / outcome plateau (months): Long-term outcomes for distal radial fractures are generally good regardless of radiological outcomes, though the likelihood of a malunion becoming symptomatic depends on patient factors and overall wrist alignment [24]. Clinical experience and literature analysis do not support the assumption that untreated distal radial fractures lead to symptomatic osteoarthritis [30]. The presence of an associated ulnar styloid fracture resulted in a slower recovery of grip strength and wrist flexion, although no long-term differences in measured impairments were observed [19]. Very old patients with distal radius fracture accompanied by ulnar styloid fractures may benefit from ORIF to achieve optimal long-term functional recovery [67].

Rehabilitation protocol: There were no significant differences in radiographic outcomes or complication rates between patients with delayed versus early surgical treatment for distal radius fracture [102]. However, a delay in time-to-surgery greater than two weeks for distal radius fractures may be associated with inferior patient-reported outcomes, with early surgery associated with improved long-term Disabilities of the Arm, Shoulder, and Hand scores [104]. Clinical and radiological results of early and delayed surgery after loss of reduction in secondary displaced distal radius fractures were similar [5].

Functional milestones: A good functional long-term outcome can be expected after both operative and non-operative treatment of radial neck fractures in adults [10]. Long-term functional outcome scores demonstrate significant disability after scaphoid nonunion, even when union is achieved [69]. Double bone forearm osteotomy in adolescence for Madelung’s deformity brought long-lasting functional improvement and provided long-term correction of distal radioulnar and radiocarpal subluxations [68]. Long-term follow-up of forearm shortening and volar radiocarpal capsulotomy for wrist flexion deformity in children with amyoplasia shows that initial improvement in wrist position is not maintained [9].

Key Evidence

  • [L4] These 2 cases represent apparent ulnar to radial dorsal wrist fracture-dislocations, characterized by dorsal dislocation and presumed ulnar to radial progression of injury with relative sparing of radial structures. (10.1016/j.jhsa.2011.12.029)
  • [L5] Optimal outcomes in the treatment of forearm fracture–dislocations depend on early recognition and management, with restoration and maintenance of anatomic alignment being the key principles. (10.1016/j.hcl.2015.01.010)
  • [L5] Most ulnar-sided wrist problems associated with distal radial fractures can be treated non-operatively initially, typically for over a year, in anticipation of substantial improvement with time. (10.1177/17531934221140238)
  • [L3] Nonoperative management of completely displaced distal radial fractures in appropriately selected cases results in excellent outcomes without exposing the child to the risks of surgery. (10.1302/0301-620x.103b.bjj-2020-1740.r1)
  • [L4] Clinical and radiological results of early and delayed surgery after loss of reduction in secondary displaced distal radius fractures were similar. (10.1016/j.jhsa.2024.07.006)
  • [L4] Despite the relative complexity of these injuries, satisfactory wrist function can be achieved with operative treatment in most patients. (10.2106/jbjs.e.00930)
  • [L5] The aim of this themed issue is to provide answers regarding the investigation and management of the unstable wrist, highlighting the need for collaborative working and the referral of cases to specialized centers to run randomized controlled trials due to the lack of objective evidence on long-term outcomes. (10.1177/1753193415617100)
  • [L4] Distal radioulnar joint instability in adolescents is often preceded by fracture of the distal radius and is often not an isolated pathoanatomical problem. (10.1177/1558944720966707)
  • [L4] Long-term follow-up of the procedure shows that the initial improvement in wrist position is not maintained. (10.1016/j.jhsa.2011.10.013)
  • [L3] A good functional long-term outcome can be expected after operative and non-operative treatment of radial neck fractures in adults. (10.1186/s13018-018-0731-3)
  • [L4] Due to the rarity of displaced fractures, only multicenter studies extending over long periods of time will lead to accurate definition of the results and prognoses associated with operatively treated fractures. (10.2106/00004623-199274020-00019)
  • [L4] Early diagnosis and management lead to an improved prognosis for isolated scaphoid dislocation. (10.1016/j.jhsg.2021.01.002)
  • [L4] Consensus on defining abnormal wrist motion and the development of a measurement device for wrist translation are needed. (10.1016/j.jhsa.2008.01.019)
  • [L3] Results from wrist scoring systems should be interpreted with caution. (10.1016/j.jhsa.2015.11.001)
  • [L4] This study demonstrates the initial performance of active-MRI, which may be useful in the investigation of dynamic wrist instability in vivo. (10.1371/journal.pone.0084004)
  • [L4] Dorsal fracture-dislocations of the radiocarpal joint are complex injuries requiring detailed surgical planning. (10.1177/1753193420926801)
  • [L4] Although radiographic carpal collapse and ulnar translocation occurred, patients were not symptomatic. (10.1016/j.jhsa.2014.12.013)
  • [L3] Tenderness of the distal radial metaphysis after wrist injury is strongly suggestive of a distal radius fracture despite both normal plain radiographs and fluoroscopic images. (10.1016/j.jhsa.2017.05.032)
  • [L2] No long-term differences in measured impairments were observed, but the presence of an associated ulnar styloid fracture resulted in a slower recovery of grip strength and wrist flexion. (10.1016/j.jhsa.2014.05.032)
  • [L4] Partial or complete tears of the ligaments of the wrist that are not detectable on standard radiographs may be the reason that some patients continue to have symptoms despite an anatomically healed fracture. (10.2106/00004623-199603000-00006)
  • [L4] The indication for using the intramedullary nail should continue to be limited to extra-articular and simple intra-articular distal radius fractures until additional data can be obtained. (10.1016/j.jhsa.2008.07.004)
  • [L4] Isolated fractures of the ulnopalmar rim of the distal radius cause radiocarpal joint instability and merit particular attention. (10.1054/jhsb.2001.0712)
  • [L4] For distal radius fractures that were initially nondisplaced or minimally displaced, the overall rate of unacceptable radiographic displacement at 6 weeks was 30%. (10.1016/j.jhsa.2021.08.006)
  • [L5] Long-term outcomes for distal radial fractures are generally good regardless of radiological outcomes, though the likelihood of a malunion becoming symptomatic remains unclear and depends on patient factors and overall wrist alignment. (10.1177/17531934231226175)
  • [L1] Adult patients with an acceptably reduced intra-articular distal radial fracture have better functional outcomes for 12 months when treated operatively instead of nonoperatively. (10.2106/jbjs.20.01344)
  • [L2] Good and equivalent functional and subjective outcome were found by both fragment-specific wrist fixation and volar locking plate fixation in primary and secondarily dislocated distal radius fractures. (10.1016/j.jhsa.2014.06.040)
  • [L4] Routine primary nonoperative management of these fractures provides a satisfactory outcome for the majority of patients, with few patients requiring further intervention for persisting complaints. (10.2106/jbjs.m.01354)
  • [L4] Subacute DRUJ subluxation after a distal radius fracture may occur early, typically under 2 weeks after the original injury and is easily overlooked. (10.1177/17531934241308137)
  • [L5] Clinical experience and literature analysis do not support the commonly held assumption that untreated distal radial fractures lead to symptomatic osteoarthritis. (10.1177/17531934241265839)
  • [L2] Late displacement occurred in 28% of cases and was associated with loss of grip strength and range of motion, but no significant differences were seen in outcome questionnaires. (10.1177/1753193417721446)
  • [L4] Metacarpophalangeal joint motion should be assessed under standardized wrist positions. (10.1177/1558944717736823)
  • [L4] Ulnar variance changed with the application of load and position of the wrist. (10.1016/j.jhsa.2023.09.010)
  • [L4] Acute distal radioulnar joint instability is primarily a clinical diagnosis, and physical examination remains a mainstay of diagnosis. (10.2106/jbjs.rvw.m.00110)
  • [L5] Clinical results for PIP joint dislocations and fracture-dislocations vary and are often difficult to predict due to the complexity of fracture patterns and potential for sub-acute or chronic presentation. (10.1177/17531934231183259)
  • [L4] In all cases, TILT repair resulted in improved wrist motion and strength. (10.1054/jhsb.1999.0070)
  • [L4] Early, accurate diagnosis of fourth and fifth CMC joint fracture-dislocations is crucial for optimizing hand function and postoperative outcomes. (10.1177/1558944720948241)
  • [L5] This document is a collection of letters to the editor and an author's reply discussing a previous biomechanical cadaveric study on distal radioulnar joint instability; it does not present new clinical data or conclusions from a primary study. (10.1016/j.injury.2006.10.027)
  • [L5] Conceptually, the forearm's bony and soft tissue structures function together as a single unit, where disruption of more than any one results in forearm instability. (10.1016/j.hcl.2020.07.010)
  • [Paper] Co-existing subluxation or dislocation of the other radioulnar articulation must not be overlooked in cases of fracture dislocation of one radioulnar joint. (10.1007/s00402-005-0805-7)
  • [L4] In vivo EPB tendon excursion measures have been quantified, and wrist position has been found to have an influence on excursion. (10.1016/j.jht.2017.12.004)
  • [L5] Prompt recognition and treatment are imperative for perilunate dislocations and fracture-dislocations. (10.5435/00124635-201109000-00006)
  • [L4] In addition, site-specific differences in the acoustic properties of the distal radial cartilage were detected in living human wrist cartilage. (10.1016/j.jhsa.2008.08.024)
  • [L4] Treatment of unstable distal radius fractures with a VLP is associated with few major complications. (10.1016/j.jhsa.2025.01.022)
  • [L5] This experimental cadaver study demonstrates a radiological method for precise quantification of distal radioulnar joint stability after different grades of triangular fibrocartilage complex injury. (10.1177/1753193420934689)
  • [L4] The SLIL generates proprioceptive stimuli at every wrist position. (10.1016/j.jhsa.2010.10.002)
  • [L4] The AO classification system provided only fair to moderate reliability when applied to radiographs of patients requiring fixation of a fracture of the distal radius, suggesting that in its current form, this system is inadequate for clinical and academic use. (10.1302/0301-620x.97b6.33844)
  • [L1] Non-operative treatment should be seriously considered for patients in this age group with redisplaced fractures of the distal radius. (10.1054/jhsb.2002.0799)
  • [L5] The DREAD classification organizes and describes articular fragment escape patterns following distal radius fracture fixation to raise awareness and facilitate decision-making. (10.1016/j.jhsa.2024.07.018)
  • [L3] Self-efficacy corresponds to wrist function after combined plating of distal radius fractures. (10.1016/j.jht.2020.01.001)
  • [L1] Early mobilization after surgical treatment of distal radius fractures does not lead to improved patient-reported outcome. (10.1016/j.jhsa.2020.05.009)
  • [L4] Pinning is an efficacious, low-cost treatment option for 2- and 3-part distal radius fractures with excellent long-term results. (10.1016/j.jhsa.2008.08.002)
  • [L1] In adult patients with a displaced and adequately reduced distal radial fracture, immobilization in a cast for four weeks is safe, and the results are similar to those after a period of immobilization of six weeks. (10.1302/0301-620x.105b9.bjj-2022-0976.r3)
  • [L4] Incorporating fracture tagging holds promise for future advancements in 3-D classifications of fractures of the distal radius. (10.1177/17531934241265681)
  • [L2] In this population distal ulna fractures can be successfully managed nonoperatively when they occur in combination with distal radius fractures. (10.1016/j.jhsa.2012.07.031)
  • [L2] Three years after surgery for unstable dorsally displaced distal radius fractures, the clinical and radiological results for VLP and EF were comparable. (10.1016/j.jhsa.2018.09.015)
  • [L3] Conservative treatment of distal radius fractures produced an increase in upper limb disability after 1 year of follow-up. (10.1177/1558944717708025)
  • [L3] Very old patients with distal radius fracture accompanied by ulnar styloid fractures may benefit from ORIF to achieve optimal long-term functional recovery. (10.1186/s12891-024-07964-3)
  • [L4] Double bone forearm osteotomy in adolescence brought long-lasting functional improvement and provided long-term correction of distal radioulnar and radiocarpal subluxations. (10.1054/jhsb.1999.0304)
  • [L4] Long-term functional outcome scores demonstrate significant disability after this injury, even when union is achieved. (10.1177/15589447211003177)
  • [L3] These findings support the need for a higher index of suspicion for scapholunate dissociation in these distal radial fracture subtypes. (10.1177/1753193419826490)
  • [L4] Based on this review, no recommendations can be made as to what defines an acceptable reduction or which fractures would benefit from surgical intervention. (10.1177/1558944715614861)
  • [L5] Surgeons should have a low threshold for operative treatment in patients with dislocated distal radial fractures, particularly in younger and working-age groups, and radiographic control is mandatory 10–14 days after initial non-operative treatment to identify marginal secondary displacement. (10.1177/17531934231166328)
  • [L4] Magnetic resonance imaging using advanced multiparametric sequences may facilitate accurate, noninvasive assessment of articular cartilage changes after distal radius fracture without the need for a contrast agent. (10.1016/j.jhsa.2020.02.009)
  • [L3] Arthroplasty should be used as an alternative to arthrodesis in the treatment of posttraumatic wrist arthritis, given the proper patient selection and indications. (10.1016/j.jhsa.2013.02.013)
  • [L1] Most elderly patients with displaced distal radius fractures can be treated nonoperatively. (10.1302/0301-620x.103b2.bjj-2020-2562)
  • [L5] Nonoperative treatment remains the most common form of treatment for distal radius fractures, though significant functional deficiencies are correlated with poor reductions. (10.1016/j.hcl.2009.08.012)
  • [L4] Acute ischaemia of the scaphoid is rare in the absence of fracture but may be more frequently detected by wrist MRI in children, especially in those presenting with significant wrist trauma and normal radiographs. (10.1054/jhsb.2000.0543)
  • [L5] Surgeons should retain a flexible approach to treatment choice and master non-operative management, as well as both external and internal skeletal fixation techniques, due to the complexity of distal radial fractures. (10.1054/jhsb.2000.0516)
  • [L4] This study demonstrates satisfactory clinical and radiographic results and minimal complications with utilization of a new fixation device for distal radius fractures with displaced dorsal lunate facet fragments. (10.1016/j.jhsa.2019.09.001)
  • [Paper] The goal of treatment is anatomic reduction and rigid internal fixation of the radial fracture along with restoration of normal distal radioulnar joint anatomy, as nonoperative management is associated with high rates of unsatisfactory results. (10.1016/j.hcl.2007.03.004)
  • [L2] The use of early MRI in patients with clinically suspected scaphoid fracture results in the accurate and reliable identification of a significant number of radiological occult injuries and early identification of patients without acute injuries. (10.1177/1753193412471008)
  • [L1] Mobilisation 10 days after reduction cannot be recommended for the routine treatment of reduced distal radius fractures. (10.1186/s13018-016-0478-7)
  • [L3] Operative management of distal radius fractures resulted in significantly fewer secondary procedures at the expense of increased overall 1-year complication rates, specifically stiffness. (10.1177/1753193420941310)
  • [L4] The Melone classification system is not suitable for characterizing all C3 fractures. (10.1186/s13018-020-01739-x)
  • [L4] The classification reflects the characteristics of intermediate column fractures of the distal radius and may provide an important reference for choosing treatment and evaluating prognosis. (10.1186/s13018-018-0925-8)
  • [L4] A moderate complication rate persisted, and accurate radial component placement is important. (10.1016/j.jhsa.2021.04.034)
  • [L4] Three morphological types of palmar ulnar corner fragments emerged, and understanding this morphology may guide optimal reduction and fixation strategy to prevent palmar radiocarpal subluxation, especially in type 3 fractures. (10.1177/17531934231211570)
  • [L3] The ligamentous attachments of the distal radius to the volar carpus in an intra-articular distal radius fracture are relatively well preserved. (10.1016/j.jhsa.2011.07.014)
  • [L4] The authors conclude that proper interpretation of radiographic imaging during and after surgery should have revealed the malpositioning, and that all perilunate fracture-dislocations deserve additional imaging (CT or MRI) to assess alignment and hardware placement. (10.1177/1753193412465062)
  • [L4] It allows for the secure identification of malpositioned screws and immediate correction, particularly in complex radius fractures. (10.1177/1753193413476418)
  • [L4] Ultrasound imaging may be useful in cases where intra-articular and/or comminuted fractures require distal plate placement and engagement of screws in the dorsal cortex. (10.1177/1753193410392869)
  • [L5] CBCT is a powerful imaging modality for evaluating wrist injuries; however, standard radiographs of the wrist should remain the routine initial diagnostic modality. (10.1016/j.jhsa.2019.07.014)
  • [L4] These fractures may be underdiagnosed, and computed tomography is recommended over plain radiography alone in case of clinical suspicion. (10.1016/j.jhsa.2012.02.046)
  • [L3] The overall incidence of adult distal forearm fractures was 207.8/100 000/year. (10.1177/15589447221109967)
  • [L4] All fractures achieved radiographic union at a mean of 9 weeks with no complications observed. (10.1177/17531934241292441)
  • [L3] MRI may be more helpful to exclude potential alternative diagnoses in the patient with ulnar wrist pain. (10.1016/j.jhsa.2013.05.040)
  • [L3] This review highlights the need for a consensus definition of scaphoid fractures on MRI scans to assess the reliability and diagnostic performance of MRI scans for diagnosing true scaphoid fractures, as well as their potential harms and benefits. (10.1177/17531934251367541)
  • [L4] Delayed diagnosis makes closed reduction difficult and was associated with less favorable radiographic outcome. (10.1177/1558944719852743)
  • [L3] The initial radiograph of a distal radius fracture does not predict a triangular fibrocartilage complex injury. (10.1177/1753193415624669)
  • [L3] Operative treatment of distal radius fracture led more often to longer time lost from work than conservative treatment. (10.1186/s12891-023-06963-0)
  • [L3] We did not find significant differences in radiographic outcomes or complication rates between patients with delayed versus early surgical treatment for distal radius fracture. (10.1177/1558944720930301)
  • [L4] A delay in time-to-surgery greater than two weeks for distal radius fractures may be associated with inferior patient-reported outcomes, with early surgery associated with improved long-term Disabilities of the Arm, Shoulder, and Hand scores. (10.1016/j.jhsa.2022.12.018)

See Also

References

[1] Ulnar to Radial Dorsal Fracture-Dislocations of the Wrist: A Report of 2 Cases. The Journal of Hand Surgery. 2012. DOI: 10.1016/j.jhsa.2011.12.029

[2] Management of Complications of Forearm Fractures. Hand Clinics. 2015. DOI: 10.1016/j.hcl.2015.01.010

[3] The distal radioulnar joint after distal radial fractures: when and how do we need to treat pain, stiffness or instability?. Journal of Hand Surgery (European Volume). 2023. DOI: 10.1177/17531934221140238

[4] Treatment of completely displaced distal radial fractures with a straight plaster or manipulation under anaesthesia. The Bone & Joint Journal. 2021. DOI: 10.1302/0301-620x.103b.bjj-2020-1740.r1

[5] Effectiveness of Delayed Surgical Treatment for Distal Radius Fractures With Loss of Reduction. The Journal of Hand Surgery. 2024. DOI: 10.1016/j.jhsa.2024.07.006

[6] Fractures of the Dorsal Articular Margin of the Distal Part of the Radius with Dorsal Radiocarpal Subluxation. The Journal of Bone & Joint Surgery. 2006. DOI: 10.2106/jbjs.e.00930

[7] Special issue: the unstable wrist. Journal of Hand Surgery (European Volume). 2015. DOI: 10.1177/1753193415617100

[8] Extensor Retinaculum Reconstruction of the Distal Radioulnar Joint in Adolescents. HAND. 2020. DOI: 10.1177/1558944720966707

[9] Long-Term Results of Forearm Shortening and Volar Radiocarpal Capsulotomy for Wrist Flexion Deformity in Children With Amyoplasia. The Journal of Hand Surgery. 2012. DOI: 10.1016/j.jhsa.2011.10.013

[10] Long-term results after non-operative and operative treatment of radial neck fractures in adults. Journal of Orthopaedic Surgery and Research. 2018. DOI: 10.1186/s13018-018-0731-3

[11] Fractures of the glenoid cavity.. The Journal of Bone & Joint Surgery. 1992. DOI: 10.2106/00004623-199274020-00019

[12] Isolated Scaphoid Dislocation From Low-Energy Wrist Trauma. Journal of Hand Surgery Global Online. 2021. DOI: 10.1016/j.jhsg.2021.01.002

[13] Quantification of Wrist Joint Laxity. The Journal of Hand Surgery. 2008. DOI: 10.1016/j.jhsa.2008.01.019

[14] Assessment Following Distal Radius Fractures: A Comparison of 4 Scoring Systems, Visual Numerical Scales, and Objective Measurements. The Journal of Hand Surgery. 2016. DOI: 10.1016/j.jhsa.2015.11.001

[15] Real-Time Magnetic Resonance Imaging (MRI) during Active Wrist Motion—Initial Observations. PLoS ONE. 2013. DOI: 10.1371/journal.pone.0084004

[16] Dorsal fracture-dislocation of the radiocarpal joint: a new classification and implications in surgical treatment. Journal of Hand Surgery (European Volume). 2020. DOI: 10.1177/1753193420926801

[17] Scaphocapitate Arthrodesis for Kienböck Disease. The Journal of Hand Surgery. 2015. DOI: 10.1016/j.jhsa.2014.12.013

[18] Predictive Power of Distal Radial Metaphyseal Tenderness for Diagnosing Occult Fracture. The Journal of Hand Surgery. 2017. DOI: 10.1016/j.jhsa.2017.05.032

[19] The Effects of Ulnar Styloid Fractures on Patients Sustaining Distal Radius Fractures. The Journal of Hand Surgery. 2014. DOI: 10.1016/j.jhsa.2014.05.032

[20] Intracarpal Soft-Tissue Lesions Associated with an Intra-Articular Fracture of the Distal End of the Radius. The Journal of Bone & Joint Surgery*. 1996. DOI: 10.2106/00004623-199603000-00006

[21] Intramedullary Fixation of Displaced Distal Radius Fractures: A Preliminary Report. The Journal of Hand Surgery. 2008. DOI: 10.1016/j.jhsa.2008.07.004

[22] Beware of the Ulno-Palmar Distal Radial Fragment. Journal of Hand Surgery. 2002. DOI: 10.1054/jhsb.2001.0712

[23] Evaluation of Risk Factors for Loss of Acceptable Alignment for Distal Radius Fractures That Are Nondisplaced or Minimally Displaced on Initial Presentation. The Journal of Hand Surgery. 2022. DOI: 10.1016/j.jhsa.2021.08.006

[24] Managing the unknowns in distal radial fractures: commentary and opinion. Journal of Hand Surgery (European Volume). 2024. DOI: 10.1177/17531934231226175

[25] Volar Plate Fixation Versus Cast Immobilization in Acceptably Reduced Intra-Articular Distal Radial Fractures. Journal of Bone and Joint Surgery. 2021. DOI: 10.2106/jbjs.20.01344

[26] A Prospective Randomized Trial Comparing Fragment-Specific Fixation and Volar Locking Plates in Displaced and Unstable Distal Radial Fractures. The Journal of Hand Surgery. 2014. DOI: 10.1016/j.jhsa.2014.06.040

[27] Long-Term Outcomes of Isolated Stable Radial Head Fractures. Journal of Bone and Joint Surgery. 2014. DOI: 10.2106/jbjs.m.01354

[28] Subacute distal radio-ulnar joint subluxation after a distal radius fracture. Journal of Hand Surgery (European Volume). 2025. DOI: 10.1177/17531934241308137

[29] Chapter 24 Carpal Instability. 2019.

[30] Does a distal radial fracture lead to osteoarthritis? Re-examining the evidence for early treatment. Journal of Hand Surgery (European Volume). 2025. DOI: 10.1177/17531934241265839

[31] The influence of late displacement in distal radius fractures on function, grip strength, range of motion and quality of life. Journal of Hand Surgery (European Volume). 2017. DOI: 10.1177/1753193417721446

[32] Influence of Wrist Position on the Metacarpophalangeal Joint Motion of the Index Through Small Finger. HAND. 2017. DOI: 10.1177/1558944717736823

[33] Altered Ulnar Variance With Full-Body Weight-Bearing During Handstands With Upper Extremity Weight-Bearing CT. The Journal of Hand Surgery. 2025. DOI: 10.1016/j.jhsa.2023.09.010

[34] Acute Distal Radioulnar Joint Instability in Adults. JBJS Reviews. 2014. DOI: 10.2106/jbjs.rvw.m.00110

[35] Proximal interphalangeal joint dislocations and fracture-dislocations. Journal of Hand Surgery (European Volume). 2023. DOI: 10.1177/17531934231183259

[36] Triquetral Impingement Ligament Tear (Tilt). Journal of Hand Surgery. 1999. DOI: 10.1054/jhsb.1999.0070

[37] Surgical Management of Ulnar Metacarpal Base Fracture-Dislocations: A Systematic Review. HAND. 2020. DOI: 10.1177/1558944720948241

[39] Distal radioulnar joint instability in distal radius fractures: The role of sigmoid notch and triangular fibrocartilage complex revisited. Injury. 2007. DOI: 10.1016/j.injury.2006.10.027

[42] Problems of Eponymous Proportions. Hand Clinics. 2020. DOI: 10.1016/j.hcl.2020.07.010

[43] The crisscross injury mechanism in forearm injuries. Archives of Orthopaedic and Trauma Surgery. 2005. DOI: 10.1007/s00402-005-0805-7

[44] Ultrasound assessment of extensor pollicis brevis tendon excursion in different wrist positions in healthy people. Journal of Hand Therapy. 2019. DOI: 10.1016/j.jht.2017.12.004

[45] Perilunate Dislocation and Perilunate Fracture-dislocation. American Academy of Orthopaedic Surgeon. 2011. DOI: 10.5435/00124635-201109000-00006

[46] A Pilot Feasibility Study for Ultrasound Evaluation of Living Human Wrist Cartilage: Site-Specific Differences in Acoustic Properties. The Journal of Hand Surgery. 2009. DOI: 10.1016/j.jhsa.2008.08.024

[49] The Rate of Major Complications Following Distal Radial Fractures Treated With One Specific Volar Locking Plate: A Retrospective Study of 1,597 Consecutive Cases in 1,564 Patients. The Journal of Hand Surgery. 2025. DOI: 10.1016/j.jhsa.2025.01.022

[51] Distal radioulnar joint stability measured with radiostereometry during the piano key test. Journal of Hand Surgery (European Volume). 2020. DOI: 10.1177/1753193420934689

[52] The Scapholunate Interosseous Ligament Afferent Proprioceptive Pathway: A Human In Vivo Experimental Study. The Journal of Hand Surgery. 2011. DOI: 10.1016/j.jhsa.2010.10.002

[54] Is it time to revisit the AO classification of fractures of the distal radius?. The Bone & Joint Journal. 2015. DOI: 10.1302/0301-620x.97b6.33844

[56] Norian SRS Versus Functional Treatment in Redisplaced Distal Radial Fractures: A Randomized Study in 20 Patients. Journal of Hand Surgery. 2002. DOI: 10.1054/jhsb.2002.0799

[57] Articular Fragment Escape and Carpal Subluxation Following Distal Radius Fracture Fixation. The Journal of Hand Surgery. 2024. DOI: 10.1016/j.jhsa.2024.07.018

[58] Self-efficacy corresponds to wrist function after combined plating of distal radius fractures. Journal of Hand Therapy. 2020. DOI: 10.1016/j.jht.2020.01.001

[60] Early Mobilization After Volar Locking Plate Osteosynthesis of Distal Radial Fractures in Older Patients—A Randomized Controlled Trial. The Journal of Hand Surgery. 2020. DOI: 10.1016/j.jhsa.2020.05.009

[61] Long-Term Outcomes of Closed Reduction and Percutaneous Pinning for the Treatment of Distal Radius Fractures. The Journal of Hand Surgery. 2008. DOI: 10.1016/j.jhsa.2008.08.002

[62] Four weeks versus six weeks of immobilization in a cast following closed reduction for displaced distal radial fractures in adult patients: a multicentre randomized controlled trial. The Bone & Joint Journal. 2023. DOI: 10.1302/0301-620x.105b9.bjj-2022-0976.r3

[63] A proposal for name-tagging three-dimensional distal radial fracture fragments based on preliminary results. Journal of Hand Surgery (European Volume). 2024. DOI: 10.1177/17531934241265681

[64] Treatment of Unstable Distal Ulna Fractures Associated With Distal Radius Fractures in Patients 65 Years and Older. The Journal of Hand Surgery. 2012. DOI: 10.1016/j.jhsa.2012.07.031

[65] External Fixation Versus Volar Locking Plate for Unstable Dorsally Displaced Distal Radius Fractures—A 3-Year Follow-Up of a Randomized Controlled Study. The Journal of Hand Surgery. 2019. DOI: 10.1016/j.jhsa.2018.09.015

[66] Conservative Treatment of Distal Radius Fractures: A Prospective Descriptive Study. HAND. 2017. DOI: 10.1177/1558944717708025

[67] Surgical intervention for distal radial fractures with concurrent ulnar styloid fractures may be beneficial for the elderly patients: a retrospective study. BMC Musculoskeletal Disorders. 2024. DOI: 10.1186/s12891-024-07964-3

[68] Long-Term Follow-Up of Surgical Correction of Madelung’s Deformity with Conservation of the Distal Radioulnar Joint in Teenagers. Journal of Hand Surgery. 2000. DOI: 10.1054/jhsb.1999.0304

[69] Scaphoid Nonunion Is a Disabling Problem in a Military Population. HAND. 2021. DOI: 10.1177/15589447211003177

[70] Association of scapholunate dissociation and two-part articular fractures of the distal radius. Journal of Hand Surgery (European Volume). 2019. DOI: 10.1177/1753193419826490

[71] Outcomes of Nonoperative Treatment of Salter-Harris II Distal Radius Fractures. HAND. 2016. DOI: 10.1177/1558944715614861

[72] Distal radial fracture management: commentary and personal opinion. Journal of Hand Surgery (European Volume). 2023. DOI: 10.1177/17531934231166328

[73] Assessment of Articular Cartilage Disorders After Distal Radius Fracture Using Biochemical and Morphological Nonenhanced Magnetic Resonance Imaging. The Journal of Hand Surgery. 2020. DOI: 10.1016/j.jhsa.2020.02.009

[74] Clinical Outcomes of Arthrodesis and Arthroplasty for the Treatment of Posttraumatic Wrist Arthritis. The Journal of Hand Surgery. 2013. DOI: 10.1016/j.jhsa.2013.02.013

[75] Infographic: Cast immobilization is non-inferior to volar locking plates in relation to QuickDASH after one year in patients aged 65 years and older: a randomized controlled trial of displaced distal radius fractures. The Bone & Joint Journal. 2021. DOI: 10.1302/0301-620x.103b2.bjj-2020-2562

[76] Distal Radius Fractures: Nonoperative and Percutaneous Pinning Treatment Options. Hand Clinics. 2010. DOI: 10.1016/j.hcl.2009.08.012

[77] Temporary Ischaemia of the Scaphoid in a Child. Journal of Hand Surgery. 2001. DOI: 10.1054/jhsb.2000.0543

[78] Should Anatomic Reduction be Pursued in Distal Radial Fractures?. Journal of Hand Surgery. 2000. DOI: 10.1054/jhsb.2000.0516

[79] Integrated Compression Screw Stabilization of the Dorsal Lunate Facet in Intra-Articular Distal Radius Fractures. The Journal of Hand Surgery. 2020. DOI: 10.1016/j.jhsa.2019.09.001

[80] Galeazzi Fractures and Dislocations. Hand Clinics. 2007. DOI: 10.1016/j.hcl.2007.03.004

[81] Early magnetic resonance imaging in patients with a clinically suspected scaphoid fracture may identify occult wrist injuries. Journal of Hand Surgery (European Volume). 2012. DOI: 10.1177/1753193412471008

[82] Radiographic results after plaster cast fixation for 10 days versus 1 month in reduced distal radius fractures: a prospective randomised study. Journal of Orthopaedic Surgery and Research. 2016. DOI: 10.1186/s13018-016-0478-7

[83] Outcomes and complications of operative versus non-operative management of distal radius fractures in adults under 65 years of age. Journal of Hand Surgery (European Volume). 2020. DOI: 10.1177/1753193420941310

[85] Melone’s concept revisited in comminuted distal radius fractures: the three-dimensional CT mapping. Journal of Orthopaedic Surgery and Research. 2020. DOI: 10.1186/s13018-020-01739-x

[86] A new classification and its value evaluation for intermediate column fractures of the distal radius. Journal of Orthopaedic Surgery and Research. 2018. DOI: 10.1186/s13018-018-0925-8

[87] Two-Year Clinical and Radiographic Evaluation of Scheker Prosthesis (Aptis) Distal Radioulnar Joint Arthroplasty. The Journal of Hand Surgery. 2022. DOI: 10.1016/j.jhsa.2021.04.034

[88] A three-dimensional computed tomography study of the palmar ulnar corner fragment in distal radial fractures. Journal of Hand Surgery (European Volume). 2023. DOI: 10.1177/17531934231211570

[89] Ligament Contribution to Patterns of Articular Fractures of the Distal Radius. The Journal of Hand Surgery. 2011. DOI: 10.1016/j.jhsa.2011.07.014

[90] An aid to flexor sheath cannulation for closed catheter irrigation of pyogenic flexor tenosynovitis. Journal of Hand Surgery (European Volume). 2012. DOI: 10.1177/1753193412465062

[91] Intraoperative C-arm CT imaging in angular stable plate osteosynthesis of distal radius fractures. Journal of Hand Surgery (European Volume). 2013. DOI: 10.1177/1753193413476418

[92] Screw prominences related to palmar locking plating of distal radius. Journal of Hand Surgery (European Volume). 2011. DOI: 10.1177/1753193410392869

[93] The Role of Cone-Beam Computed Tomography (CBCT) Scan for Detection and Follow-Up of Traumatic Wrist Pathologies. The Journal of Hand Surgery. 2019. DOI: 10.1016/j.jhsa.2019.07.014

[94] Trapezoid Fractures: Report of 11 Cases. The Journal of Hand Surgery. 2012. DOI: 10.1016/j.jhsa.2012.02.046

[95] Epidemiology of Distal Forearm Fracture: A Population-Based Study of 5426 Fractures. HAND. 2022. DOI: 10.1177/15589447221109967

[96] Robot-assisted percutaneous scaphoid fixation: patient-reported outcomes and learning curve at two centres. Journal of Hand Surgery (European Volume). 2024. DOI: 10.1177/17531934241292441

[97] Utility of Magnetic Resonance Imaging for Detection of Longitudinal Split Tear of the Ulnotriquetral Ligament. The Journal of Hand Surgery. 2013. DOI: 10.1016/j.jhsa.2013.05.040

[98] Variation in definitions of scaphoid fracture on MRI scans for suspected fracture: a systematic review. Journal of Hand Surgery (European Volume). 2025. DOI: 10.1177/17531934251367541

[99] Carpometacarpal Fracture-Dislocations: A Retrospective Review of Injury Characteristics and Radiographic Outcomes. HAND. 2019. DOI: 10.1177/1558944719852743

[100] The correlation of initial radiographic characteristics of distal radius fractures and injuries of the triangular fibrocartilage complex. Journal of Hand Surgery (European Volume). 2016. DOI: 10.1177/1753193415624669

[101] Sick leave length and the costs of operatively and conservatively treated distal radius fractures in the working age population: a retrospective cohort study. BMC Musculoskeletal Disorders. 2023. DOI: 10.1186/s12891-023-06963-0

[102] Radiographic Outcomes and Complications of Delayed Fixation of Distal Radius Fractures. HAND. 2020. DOI: 10.1177/1558944720930301

[104] Effect of Time-To-Surgery on Distal Radius Fracture Outcomes: A Systematic Review. The Journal of Hand Surgery. 2023. DOI: 10.1016/j.jhsa.2022.12.018

Creative Commons BY-NC 4.0

CC Creative Commons licence
BY Attribution — you must credit the source
NC NonCommercial — not for commercial use

Attribution-NonCommercial 4.0 International

Creative Commons Corporation ("Creative Commons") is not a law firm and does not provide legal services or legal advice. Distribution of Creative Commons public licenses does not create a lawyer-client or other relationship. Creative Commons makes its licenses and related information available on an "as-is" basis. Creative Commons gives no warranties regarding its licenses, any material licensed under their terms and conditions, or any related information. Creative Commons disclaims all liability for damages resulting from their use to the fullest extent possible.

Using Creative Commons Public Licenses

Creative Commons public licenses provide a standard set of terms and conditions that creators and other rights holders may use to share original works of authorship and other material subject to copyright and certain other rights specified in the public license below. The following considerations are for informational purposes only, are not exhaustive, and do not form part of our licenses.

Considerations for licensors: Our public licenses are intended for use by those authorized to give the public permission to use material in ways otherwise restricted by copyright and certain other rights. Our licenses are irrevocable. Licensors should read and understand the terms and conditions of the license they choose before applying it. Licensors should also secure all rights necessary before applying our licenses so that the public can reuse the material as expected. Licensors should clearly mark any material not subject to the license. This includes other CC- licensed material, or material used under an exception or limitation to copyright. More considerations for licensors: wiki.creativecommons.org/Considerations_for_licensors

Considerations for the public: By using one of our public licenses, a licensor grants the public permission to use the licensed material under specified terms and conditions. If the licensor's permission is not necessary for any reason--for example, because of any applicable exception or limitation to copyright--then that use is not regulated by the license. Our licenses grant only permissions under copyright and certain other rights that a licensor has authority to grant. Use of the licensed material may still be restricted for other reasons, including because others have copyright or other rights in the material. A licensor may make special requests, such as asking that all changes be marked or described. Although not required by our licenses, you are encouraged to respect those requests where reasonable. More considerations for the public: wiki.creativecommons.org/Considerations_for_licensees

Creative Commons Attribution-NonCommercial 4.0 International Public License

By exercising the Licensed Rights (defined below), You accept and agree to be bound by the terms and conditions of this Creative Commons Attribution-NonCommercial 4.0 International Public License ("Public License"). To the extent this Public License may be interpreted as a contract, You are granted the Licensed Rights in consideration of Your acceptance of these terms and conditions, and the Licensor grants You such rights in consideration of benefits the Licensor receives from making the Licensed Material available under these terms and conditions.

Section 1 -- Definitions.

a. Adapted Material means material subject to Copyright and Similar Rights that is derived from or based upon the Licensed Material and in which the Licensed Material is translated, altered, arranged, transformed, or otherwise modified in a manner requiring permission under the Copyright and Similar Rights held by the Licensor. For purposes of this Public License, where the Licensed Material is a musical work, performance, or sound recording, Adapted Material is always produced where the Licensed Material is synched in timed relation with a moving image.

b. Adapter's License means the license You apply to Your Copyright and Similar Rights in Your contributions to Adapted Material in accordance with the terms and conditions of this Public License.

c. Copyright and Similar Rights means copyright and/or similar rights closely related to copyright including, without limitation, performance, broadcast, sound recording, and Sui Generis Database Rights, without regard to how the rights are labeled or categorized. For purposes of this Public License, the rights specified in Section 2(b)(1)-(2) are not Copyright and Similar Rights.

d. Effective Technological Measures means those measures that, in the absence of proper authority, may not be circumvented under laws fulfilling obligations under Article 11 of the WIPO Copyright Treaty adopted on December 20, 1996, and/or similar international agreements.

e. Exceptions and Limitations means fair use, fair dealing, and/or any other exception or limitation to Copyright and Similar Rights that applies to Your use of the Licensed Material.

f. Licensed Material means the artistic or literary work, database, or other material to which the Licensor applied this Public License.

g. Licensed Rights means the rights granted to You subject to the terms and conditions of this Public License, which are limited to all Copyright and Similar Rights that apply to Your use of the Licensed Material and that the Licensor has authority to license.

h. Licensor means the individual(s) or entity(ies) granting rights under this Public License.

i. NonCommercial means not primarily intended for or directed towards commercial advantage or monetary compensation. For purposes of this Public License, the exchange of the Licensed Material for other material subject to Copyright and Similar Rights by digital file-sharing or similar means is NonCommercial provided there is no payment of monetary compensation in connection with the exchange.

j. Share means to provide material to the public by any means or process that requires permission under the Licensed Rights, such as reproduction, public display, public performance, distribution, dissemination, communication, or importation, and to make material available to the public including in ways that members of the public may access the material from a place and at a time individually chosen by them.

k. Sui Generis Database Rights means rights other than copyright resulting from Directive 96/9/EC of the European Parliament and of the Council of 11 March 1996 on the legal protection of databases, as amended and/or succeeded, as well as other essentially equivalent rights anywhere in the world.

l. You means the individual or entity exercising the Licensed Rights under this Public License. Your has a corresponding meaning.

Section 2 -- Scope.

a. License grant.

1. Subject to the terms and conditions of this Public License, the Licensor hereby grants You a worldwide, royalty-free, non-sublicensable, non-exclusive, irrevocable license to exercise the Licensed Rights in the Licensed Material to:

a. reproduce and Share the Licensed Material, in whole or in part, for NonCommercial purposes only; and

b. produce, reproduce, and Share Adapted Material for NonCommercial purposes only.

2. Exceptions and Limitations. For the avoidance of doubt, where Exceptions and Limitations apply to Your use, this Public License does not apply, and You do not need to comply with its terms and conditions.

3. Term. The term of this Public License is specified in Section 6(a).

4. Media and formats; technical modifications allowed. The Licensor authorizes You to exercise the Licensed Rights in all media and formats whether now known or hereafter created, and to make technical modifications necessary to do so. The Licensor waives and/or agrees not to assert any right or authority to forbid You from making technical modifications necessary to exercise the Licensed Rights, including technical modifications necessary to circumvent Effective Technological Measures. For purposes of this Public License, simply making modifications authorized by this Section 2(a) (4) never produces Adapted Material.

5. Downstream recipients.

a. Offer from the Licensor -- Licensed Material. Every recipient of the Licensed Material automatically receives an offer from the Licensor to exercise the Licensed Rights under the terms and conditions of this Public License.

b. No downstream restrictions. You may not offer or impose any additional or different terms or conditions on, or apply any Effective Technological Measures to, the Licensed Material if doing so restricts exercise of the Licensed Rights by any recipient of the Licensed Material.

6. No endorsement. Nothing in this Public License constitutes or may be construed as permission to assert or imply that You are, or that Your use of the Licensed Material is, connected with, or sponsored, endorsed, or granted official status by, the Licensor or others designated to receive attribution as provided in Section 3(a)(1)(A)(i).

b. Other rights.

1. Moral rights, such as the right of integrity, are not licensed under this Public License, nor are publicity, privacy, and/or other similar personality rights; however, to the extent possible, the Licensor waives and/or agrees not to assert any such rights held by the Licensor to the limited extent necessary to allow You to exercise the Licensed Rights, but not otherwise.

2. Patent and trademark rights are not licensed under this Public License.

3. To the extent possible, the Licensor waives any right to collect royalties from You for the exercise of the Licensed Rights, whether directly or through a collecting society under any voluntary or waivable statutory or compulsory licensing scheme. In all other cases the Licensor expressly reserves any right to collect such royalties, including when the Licensed Material is used other than for NonCommercial purposes.

Section 3 -- License Conditions.

Your exercise of the Licensed Rights is expressly made subject to the following conditions.

a. Attribution.

1. If You Share the Licensed Material (including in modified form), You must:

a. retain the following if it is supplied by the Licensor with the Licensed Material:

i. identification of the creator(s) of the Licensed Material and any others designated to receive attribution, in any reasonable manner requested by the Licensor (including by pseudonym if designated);

ii. a copyright notice;

iii. a notice that refers to this Public License;

iv. a notice that refers to the disclaimer of warranties;

v. a URI or hyperlink to the Licensed Material to the extent reasonably practicable;

b. indicate if You modified the Licensed Material and retain an indication of any previous modifications; and

c. indicate the Licensed Material is licensed under this Public License, and include the text of, or the URI or hyperlink to, this Public License.

2. You may satisfy the conditions in Section 3(a)(1) in any reasonable manner based on the medium, means, and context in which You Share the Licensed Material. For example, it may be reasonable to satisfy the conditions by providing a URI or hyperlink to a resource that includes the required information.

3. If requested by the Licensor, You must remove any of the information required by Section 3(a)(1)(A) to the extent reasonably practicable.

4. If You Share Adapted Material You produce, the Adapter's License You apply must not prevent recipients of the Adapted Material from complying with this Public License.

Section 4 -- Sui Generis Database Rights.

Where the Licensed Rights include Sui Generis Database Rights that apply to Your use of the Licensed Material:

a. for the avoidance of doubt, Section 2(a)(1) grants You the right to extract, reuse, reproduce, and Share all or a substantial portion of the contents of the database for NonCommercial purposes only;

b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.