The distal radius is the most commonly fractured bone in the human body, forming the radiocarpal articular surface (sigmoid notch radially, lunate and scaphoid facets distally) and the sigmoid notch for the distal radioulnar joint medially. Normal anatomy: 22-23 degrees radial inclination, 11-12 degrees volar tilt (palmar angulation), 1-3 mm radial height, and neutral or negative ulnar variance. Restoration of these parameters is the goal of fracture fixation.
Distal radius fractures (Colles — dorsally displaced; Smith — volarly displaced; Barton — intraarticular rim fracture) are classified by the AO/OTA system. Fixation with volar locking plates restores the palmar volar tilt and maintains fracture reduction while allowing early wrist mobilisation. EPL rupture from Lister's tubercle attrition is a late complication of undisplaced distal radius fractures treated conservatively. Malunion with loss of radial height and volar tilt produces carpal malalignment, wrist pain, and DRUJ incongruity requiring corrective osteotomy.
Dorsally displaced distal radius fracture with greater than 20 degrees dorsal tilt, more than 2 mm articular step, or radial shortening greater than 3 mm requires reduction and fixation; volar locking plate through the FCR approach restores the volar tilt and radial height under fluoroscopy with the plate placed distal to the watershed line to prevent flexor tendon impingement.
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