Editing Distal radius fracture (section)

==== Little joint involvement ====
These fractures are the most common of the three groups mentioned above that require surgical management.<ref name="Court-Brown 2015"/> A minimal articular fracture involves the joint, but does not require reduction of the joint. Manipulative reduction and immobilization were thought to be appropriate for metaphyseal unstable fractures. However, several studies suggest this approach is largely ineffective in patients with high functional demand, and in this case, more stable fixation techniques should be used.<ref>{{cite journal |last1=McQueen |first1=M. M. |last2=Hajducka |first2=C. |last3=Court-Brown |first3=C. M. |title=Redisplaced unstable fractures of the distal radius |journal=The Journal of Bone and Joint Surgery. British Volume |date=1 May 1996 |volume=78-B |issue=3 |pages=404–409 |doi=10.1302/0301-620X.78B3.0780404 |pmid=8636175 }}</ref><ref>{{cite journal |last1=McQueen |first1=MM |last2=MacLaren |first2=A |last3=Chalmers |first3=J |title=The value of remanipulating Colles' fractures |journal=The Journal of Bone and Joint Surgery. British Volume |date=1 March 1986 |volume=68-B |issue=2 |pages=232–233 |doi=10.1302/0301-620X.68B2.3958009 |pmid=3958009 }}</ref><ref>{{cite journal |last1=Schmalholz |first1=Anders |title=Epidemiology of distal radius fracture in Stockholm 1981–82 |journal=Acta Orthopaedica Scandinavica |date=1 January 1988 |volume=59 |issue=6 |pages=701–703 |doi=10.3109/17453678809149429 |pmid=3213460 |doi-access=free }}</ref>

Surgical options have been shown to be successful in patients with unstable extra-articular or minimal articular distal radius fractures. These options include percutaneous pinning, external fixation, and ORIF using plating. Patients with low functional demand of their wrists can be treated successfully with nonsurgical management; however, in more active and fit patients with fractures that are reducible by closed means, nonbridging external fixation is preferred, as it has less serious complications when compared to other surgical options.<ref name="Court-Brown 2015"/> The most common complication associated with nonbridging external fixation is pin tract infection, which can be managed with antibiotics and frequent dressing changes, and rarely results in reoperation.<ref name="Court-Brown 2015"/> The external fixator is placed for 5 to 6 weeks and can be removed in an outpatient setting.<ref name="Court-Brown 2015"/>

If the fractures are unlikely to be reduced by closed means, open reduction with internal plate fixation is preferred.<ref name="Court-Brown 2015"/> Although major complications (i.e. tendon injury, fracture collapse, or malunion) result in higher reoperation rates (36.5%) compared to external fixation (6%), ORIF is preferred, as this provides better stability and restoration of the volar tilt.<ref name="Court-Brown 2015"/><ref>{{cite journal |last1=Gradl |first1=Georg |last2=Gradl |first2=Gertraud |last3=Wendt |first3=Martina |last4=Mittlmeier |first4=Thomas |last5=Kundt |first5=Guenther |last6=Jupiter |first6=Jesse B. |title=Non-bridging external fixation employing multiplanar K-wires versus volar locked plating for dorsally displaced fractures of the distal radius |journal=Archives of Orthopaedic and Trauma Surgery |date=1 May 2013 |volume=133 |issue=5 |pages=595–602 |doi=10.1007/s00402-013-1698-5 |pmid=23420065 |s2cid=10456360 }}</ref> Following the operation, a removable splint is placed for 2 weeks, during which time patients should mobilize the wrist as tolerated.<ref name="Court-Brown 2015"/>