Surgical therapy | Therapy of a fracture of the spoke and wrist

Surgical therapy

All unstable fractures and those with accompanying vascular and nerve injuries must be treated surgically. The same applies to fractures where no satisfactory fracture repair is possible. Before any operation, the patient must be informed about the type of procedure, alternatives, risks and chances of success and give his or her written consent.

Decisive for the selected surgical procedure (osteosynthesis procedure) are the fracture type (classification), the age of the patient, the bone quality and accompanying soft tissue injuries. As a rule, the operation is performed on the day of the accident as an emergency. In the case of severe soft tissue swelling, it may be necessary to wait 3-5 days (in the meantime, elevation, cooling, immobilization in a plaster cast) until the operation can be performed.

  • Larding wire osteosynthesis: The fracture is closed and stabilized from the inside with wires inserted through the skin. The wires bridge the fracture zone and are fixed in the opposite bone wall (cortex). The wire ends are then shortened below skin level.

    After the operation, an additional plaster splint is applied on the stretching side (dorsal), because the wires alone do not usually create a stable situation for exercises. 6 weeks after the operation, the inserted wires can be removed in a small outpatient procedure under local anesthesia. Advantage: Small, less stressful surgical procedure Disadvantage: No reliable stability during exercise.

    Plaster necessary. Follow-up surgery necessary.

  • Plate osteosynthesis: The best fracture stabilization is achieved by plating the fracture zone. Angular stable plates are particularly suitable for this purpose, as they achieve a very high fracture stabilization. The plates are inserted either on the extension or flexion side of the wrist.

X-ray image of the wrist fracture seen from the side. The left image shows the fracture, on the right the fracture was treated with a plate.

Spoke fracture surgery

Plate and screwsPreferably, the plate should be placed on the flexion side of the eye, because the stretched vision may be irritated on the extension side, which runs directly over the implanted plate without any greater soft-tissue protection. Fractures with poor bone substance, such as osteoporotic fractures, can also be stabilized well with angular stable plates. Postoperative application of a plaster splint is not necessary.

Physiotherapeutic exercises can begin immediately after the operation. The titanium plates do not necessarily have to be removed. Advantage: Immediate exercise stability.

Implant retention possible. Disadvantage: major surgery. External bone tensioner (external fixator)The treatment of a radius fracture with an external fixator is reserved for certain problem cases.

Use is considered in open fractures, extensive comminuted fractures, intra-articular fractures and infected fractures. The therapeutic principle is to stabilize the fracture after the fracture has been closed with an external, joint-bridging fixator. For this purpose, screws (Schanz screws) are inserted into the distal radius bone and the second metacarpal bone and clamped together with clamps and rods.

Advantage: Fracture stabilization is possible in difficult soft tissue and bone conditions. Disadvantage: Usually change of procedure necessary (wire picking/plate). False joint formations are more frequently observed when treated in the fixator.