As for treatment of fractures of both bones of Forearm, the implant of choice is limited contact dynamic compression plate and 3.5 mm screws.
Using dorsal or volar approach, the radius fragments are exposed and reduced. The fracture is fixed with implant of suitable size usually 6 or 7 hole plates but may be 5 holes in case one fragment is very small.
If fracture is transverse, the plate is applied in compression mode. However, in case of comminution putting the plate in compression m0de would pull the radius from distal to fracture site. This could lead to disturbance of normal radius and ulna relation. This can cause malfunction of the wrist. Therefore, in case of extensive comminution distally, the palte should be applied in neutralizing mode.
Assessment and Treatment of Distal Radioulnar Joint Stability
Clinically, distal radioulnar joint stability is assessed by ballottement of the distal ulna relative to the distal radius. If xray imaging is available, a radiological confirmation can be done peroperatively.
Most commonly, after fixation of radius bone fracture distal radioulnar joint gets reduced and stable. Nothing more needs to be done in this situation. Wound is closed and a well padded dressing should be done. Mobilization can be allowed as son as patient is able to do it.
If the joint is reducible but unstable, then the postiion of maximum stability should be found and limb should be splinted in that position. The splint is continued for 4 weeks after the injury and the mobilization of the limb should begin. Night splinting in the stable position should continued until 3 months after injury.
If no stable position can be found, the distal radioulnar joint should be stabilized with a radioulnar pin for 3 weeks. Alternatively a screw can be used if greater stabilization is needed. The problem with screw is difficult removal.
very rarely the joint may not be reducible at all. his usually happens in case of malreduction of the radius or soft tissue interposition within the joint.
If the reduction is anatomic and joint is not reducible post fixation, open reduction of the distal radioulnar joint is required.
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