Rockwood Children CH8

276

SECTION TWO • Upper Extremity

Technique

Given the spectrum of intra-articular distal radius fracture pat- terns, a sequential description of surgical steps is difficult; each patient must be treated in an individualized fashion according to fracture pattern, size of bony fragments, severity of displace- ment, and skeletal maturity. Universal surgical principles of adequate fracture reduction, anatomic realignment, and stable fixation will provide for optimal results. A few additional con- siderations are important. Attempts should be made to achieve closed or minimally invasive reduction whenever possible. With adequate anes- thesia, muscle relaxation, and traction, displaced articular fragments may often be anatomically realigned, facilitating percutaneous fixation or implant placement without violating

✔ ✔ Fixation of Intra-Articular Fractures: SURGICAL PRINCIPLES

❑❑ Careful preoperative evaluation of fracture pattern, comminution, and displacement ❑❑ Fracture-specific surgical approaches ❑❑ Articular realignment • Use of traction, wrist arthroscopy, fluoroscopy, or arthrotomy to aid in visualization ❑❑ Stabilization of the articular surface to the proximal radius ❑❑ Fixation using K-wires, interfragmentary screws, or plate-and- screw constructs for maintenance of alignment

A

Figure 8-43.  A: Displaced distal radius metaphyseal and intra-articular fracture. B: Emergency department postreduc- tion radiographs in cast.

B