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Controversies in the Management of Distal Radius Fractures

Koval, Kenneth MD; Haidukewych, George J. MD; Service, Benjamin MD; Zirgibel, Brian J. MD

JAAOS - Journal of the American Academy of Orthopaedic Surgeons: September 2014 - Volume 22 - Issue 9 - p 566–575
doi: 10.5435/JAAOS-22-09-566
Review Article

Controversies span the entire spectrum of management of distal radius fractures—fracture assessment, diagnosis, treatment, and evaluation of outcomes. The utility of multiple radiographic views described in the literature has not been validated. Likewise, the several classification systems that exist have yet to demonstrate substantial interobserver and intraobserver reliability. Nonsurgical controversies involve fracture reduction, use of anesthesia, type of fracture immobilization, and forearm position during healing. Surgical controversies include surgical indications, need for release of carpal tunnel, fracture fixation method, and the need for augmentation (ie, bone graft). Postoperatively, rehabilitation, medication, and physical therapy also remain highly controversial. The best outcome measure has yet to be established. A strong need remains for high-level, prospective studies to determine the most effective way to assess, diagnose, treat, and measure outcomes in patients with distal radius fractures.

From Level One Orthopedics at Orlando Health, Orlando, FL (Dr. Koval and Dr. Haidukewych) and the Orlando Health Orthopedic Residency Program, Orlando (Dr. Service and Dr. Zirgibel.

Dr. Koval or an immediate family member has received royalties from Biomet, is a member of a speakers’ bureau or has made paid presentations on behalf of Biomet and Stryker, serves as a paid consultant to Biomet, and serves as a board member, owner, officer, or committee member of the American Academy of Orthopaedic Surgeons and the Orthopaedic Trauma Association. Dr. Haidukewych or an immediate family member has received royalties from DePuy and Biomet; serves as a paid consultant to Smith & Nephew, Synthes, and DePuy; has stocks or stock options held in Orthopediatrics and the Institute for Better Bone Health; has received nonincome support (such as equipment or services), commercially derived honoraria, or other non-research–related funding (such as paid travel) from Synthes; and serves as a board member, owner, officer, or committee member of the American Academy of Orthopaedic Surgeons. Neither of the following authors nor any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Service and Dr. Zirgibel.

© 2014 by American Academy of Orthopaedic Surgeons
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