Fractures of the Distal Radius: A Practical Approach to Management

414 Pages·2002·27.498 MB·English

by  Diego L. Fernandez M.D., Jesse B. Jupiter M.D. (auth.)

Fractures of the Distal Radius
Second Edition
Springer Science+Business Media, LLC
Fractures of the
Distal Radius
A Practical Approach to Management
Second Edition
With 371 illustrations in 698 parts
Diego L. Fernandez, M.D.
Professor, Orthopaedic Surgery
University of Bem, and
Staff Member, Orthopaedic Department
Lindenhof Hospital Bem
Jesse B. Jupiter, M.D.
Professor, Orthopaedic Surgery
Harvard Medical School, and
Director, Orthopaedic Hand Service
Massachusetts General Hospital
Springer
Diego L. Femandez, M.D.
Professor, Orthopaedic Surgery
University of Bem, and
Staff Member, Orthopaedic Department
Lindenhof Hospital Bem
Mittelstr. 54
3012 Bem, Switzerland
Jesse B. Jupiter, M.D.
Professor, Orthopaedic Surgery
Harvard Medical School, and
Director, Orthopaedic Hand Service
Massachusetts General Hospital
ACC 527, 15 Parkman Street
Boston, MA 02114, USA
Library of Congress Cataloging-in-Publication Data
Fernandez, Diego L.
Fractures of the distal radius: a practical approach to management / Diego L.
Fernandez, Jesse B. Jupiter.-2nd ed.
p. cm.
Includes bibliographical references and index.
ISBN 978-1-4612-6536-8 ISBN 978-1-4613-0033-5 (eBook)
DOI 10.1007/978-1-4613-0033-5
1. Radius-Fractures. 1. Jupiter, Jesse B. II. Title.
[DNLM: 1. Radius Fractures. WE 820 F363f 2002]
RD557 .]68 2002
617.1'57-dc21 2001041112
Printed on acid-free paper.
© 2002 Springer Science+Business Media New York
Originally published by Springer-Verlag New York, Ine. in 2002
Softcover reprint of the hardcover 2nd edition 2002
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ISBN 978-1-4612-6536-8 SPIN 10790021
Dedicated to Our Fathers
Leoncio Luis Fernandez, MD.
Samuel Jacob Jupiter
There is a dead medical literature and there is a
live one. The dead is not all ancient and the live
is not all modern.
-Oliver Wendell Holmes
Foreword to the
Second Edition
The authors are to be congratulated on producing this new edition of their
book Fractures of the Distal Radius. It is timely because the management of
fractures of the distal radius has changed markedly during the past 25 years
and has changed more rapidly recently. An update every 4 to 5 years is
appropriate.
This volume is well written, as was the original volume. The authors have
maintained a format similar to the first edition by stating a problem, review-
ing the accepted treatments for the specific fracture or injury type, and then
discussing the best treatment on the basis of their own experience. This
volume is as detailed as the original volume, with some important additions.
There are numerous new illustrations; new concepts of anatomy are pre-
sented; and in each chapter the authors have added an important discussion
of outcomes. They do this by reviewing studies published since their first
edition and, most important, their own published experiences since the first
edition. Examples include an expanded section on the Kapandji percutaneous
fixation and surgical techniques with reviews of additional studies on closed
reduction and percutaneous pinning under arthroscopic control, as well as
use of "bridging" external fixators and dynamic fixators.
They begin their book with a wonderful chapter on historical perspectives,
unchanged from their first edition. It is a well written, comprehensive review
of the history of fractures of the distal radius, and it is recommended reading
for everyone. In Chapter 2, on epidemiology and classification, they have
added epidemiologic studies from Europe and new perspectives on the clas-
sification of these injuries. Intraobserver and interobserver accuracy and reli-
ability are shown to be inconsistent in these complex classification systems.
Chapter 3 has added new concepts on anatomy, discussing the column theory,
the components of injury, and new data on x-ray correlation of distal radius
rim fractures. They conclude with a brief section on how computed tomog-
raphy has improved our understanding of complex fractures of the distal
radius.
A new section on extraarticular bending fractures reviews the timeframe for
bone healing and its relation to outcome. The authors point out the "hard-
ships of losing full use of the upper extremity for 6-8 weeks, which provokes
notable suffering with a considerable negative impact on function." They
review various outcome instruments and discuss objective rating scales
for radiologic interpretation of healing and the use of bone graft substitutes
(NorianSRS). They include early and late complications in their personal series
on articular marginal shearing fractures, the results of a randomized clinical
trial showing better results with indirect reduction in the chapter entitled Com-
pression Fractures of the Articular Surface. A section has been added about
correct angulations and rotation on the single-cut osteotomy written by a new
coauthor Ladislav Nagy. In the chapter Early Complications, an added dis-
viii
Foreword to the Second Edition
cussion of nerve injuries and nonunion of distal radius fractures is helpful to
the reader.
In Chapter 7, which deals with compression fractures of the articular surface,
the authors have added a section on ligament injuries in the wrist. They discuss
mechanisms of injury, classification, and the use of arthroscopy to help with
the diagnosis; and they review early and late treatment options. The authors
recognize the problems of associated tendon rupture with the use of dorsal
plates and now recommend that dorsal plates be removed, although volar
plates can remain in place indefinitely. An important addition in Chapter 9
on complex fractures of the distal radius is a discussion of fractures in the
"active elderly patient." They strongly recommend that orthopaedic surgeons
should not be influenced by age or osteoporosis when managing these
complex injuries.
Finally, the authors have added a new chapter, Acute and Chronic Derange-
ment of the Distal Radioulnar Joint. This joint has been poorly understood
and neglected. Only recently have orthopaedic surgeons addressed this com-
plex joint more thoroughly by assessing its injury patterns and developing
more aggressive early management. Early management can prevent the limi-
tation of forearm rotation and pain so commonly seen in patients as a con-
sequence of these complex injuries. The authors have provided an interesting
perspective of treatment options including functional aftercare, cast immo-
bilization, and open and arthroscopic surgical approaches. They provide a
unique decision tree for the orthopaedic surgeon managing these injuries in
both the acute and chronic setting.
I recommend this book not only to those who are subspecialty-trained in
trauma or hand surgery but especially to the general orthopaedist and all
orthopaedists who have occasion to treat these patients, both young adults
and the elderly. With increasing life-spans and longer retirements for most of
us, careful and accurate management of the complex injuries of the distal
radius is important for our patients' function, appearance, and well-being.
James H. Herndon
Foreword to the
First Edition
At first glance at this volume, it is easy to ask "why so much about so little?"
After all the distal radius is only a small part of the body and its fractures,
although common, are really not exactly a life- or limb-threatening issue.
Admittedly it is a fracture that we often do not deal with well, but is that
really worth an entire volume? How wrong one would be with that attitude!
How truly inappropriate is such a view of this truly spectacular and well-
written compendium of important technology and information!
Fractures of the Distal Radius is truly a remarkable effort and one that by
all standards offers the reader a practical guide to the diagnosis and man-
agement of distal radius fractures and their sequellae. Each of the manage-
ment chapters provide the reader with methods of identifying the injury,
techniques of anesthesia, reduction, fixation, immobilization, aftercare, poten-
tial complications and their management and expected and achieved out-
comes. All types of injuries are detailed, and all methods of treatment
including closed techniques are described. This it would seem would be suf-
ficient for a book about an injury, especially one as frequently encountered
and as seemingly prosaic as fractures of the radius. As important as that goal
is, however, it is not alone the purpose, nor in this essayist's opinion, the
principal achievement of this remarkable volume.
The book has been written by two outstanding surgeons who not only
describe the lesions and the best treatment on the basis of their own experi-
ence, but in addition provide the readers with a broad panoply of method-
ology for the management of the injuries based not just on what is successful
in their own hands, but on a careful assessment of an extraordinarily volu-
minous body of literature. No stone lies unturned by Drs. Fernandez and
Jupiter in providing the reader with every recorded classification system and
their strengths, weaknesses and difficulties of application. At the same time
they offer as their choice the new Fernandez approach which to this reader
seems to make sense out of potential chaos and confusion. This alone is
perhaps worth the price of the volume and is a truly valuable contribution.
Of perhaps greater interest to some of us is the evident fact that the authors
display for this day and age, a rather astounding reverence for history. The
first chapter clearly demonstrates this point and despite its lack of direct appli-
cation to management of the injured patient (which after all is what the book
is about) is for some of us, the most edifying and entertaining section. It
describes in remarkably clear fashion the extraordinary, centuries-old strug-
gle since the time of ancient Greece to define and describe this very common
injury. Faced with the complex anatomy of the wrist, lack of anatomical speci-
mens of the fractures (very few autopsies were done then or even now for
injuries about the wrist), and of course the absence of imaging studies, the
ancients were appropriately puzzled by the injury and the ensuing deformi-
ties. Fractures and dislocations were confused with one another and the puta-
x
Foreword to the First Edition
tive site of injury (as in the eponymically immortalized Abraham Colles' case)
was often far from the place which we now know is the actual location of
the fracture. It is amazingly evident that Smith, Barton, Colles, Dupuytren,
Malgaigne, Goyrand, Petit, Cotton and the rest (including Velpeau ... pre-
sumably of shoulder immobilization fame, who gave the deformity the name
of "talon de fourchette" or the "silver fork deformity") all described features
of these often eponymously immortalized injuries prior to the first X-ray
picture taken by Wilhelm Conrad Roentgen just about 100 years ago (and
appropriately for this volume of his wife's hand and wrist!). The struggle for
definition of the fact of these injuries is eloquently described by the authors,
in many cases by direct quotes from these ancient sources and in fact, really
paraphrases the development of modern medicine throughout the centuries.
Seminal observations by ancient scholars using the tools of their day add a
bit to knowledge. Others in the next generation, or even next century, build
on these data with new observations until with modern technology and
systems of study we come upon what passes for current-day "truth." This is
true until another generation extends these observations and establishes yet
another plateau of knowledge. This then is the way of learning about disease,
and no more careful assessment of the role of such a process can be encoun-
tered than is found in the exposition of the diagnosis, classification, and man-
agement of fractures of the distal radius in this very book. We are indebted
to the authors for this remarkable and stunning exposition of the history of
what has been mistaken by many modern clinicians to be a straight-forward
problem, but has been clearly shown by them to be a tangled and sometimes
confusing web of fact and fancy surrounding a series of complex anatomical
and functional problems.
Henry j. Mankin