Excessive pressure may produce symptomatic carpal tunnel syndrome that may necessitate emergent release or contribute to the development of complex regional pain syndrome after distal radius fracture. Distal radius fractures increase pressure within the carpal tunnel, a finding potentiated by immobilization in a position of wrist flexion. The median nerve and flexor tendons for the fingers course volar to the distal radius. Finally, loss of radius length producing an ulnar positive wrist increases the chance of symptomatic ulnar impaction syndrome. When clinically relevant changes in lateral tilt or radius shortening occur, patients may also experience restricted forearm rotation secondary to altered distal radial-ulnar joint mechanics. Altered lateral tilt of the articular surface may produce visible deformity but is more important as a cause of adaptive midcarpal instability which is one cause of long-term wrist pain secondary to the malalignment between the lunate and capitate. Decreased radial height and inclination result in a hand that appears radially deviated with increased prominence of the ulnar head. After fracture, change from these normative values or change compared to the opposite uninjured radius is assessed and often guides the decision to pursue operative treatment versus non-operative immobilization. Several measurements describe the normal distal radius: height (radius styloid 12-mm longer than the ulnar corner of the lunate facet), lateral tilt (11 degrees volar), inclination (22°), and length relative to the ulna (neutral variance). The distal radius has three articular facets, the scaphoid facet, lunate facet, and sigmoid notch articulating with the scaphoid, lunate, and distal ulna, respectively. We will discuss all of these components as they pertain to the treatment of distal radius fracture in athletes. The most common question for athletes, and perhaps the most difficult to answer, is predicting the timing of return to play. Currently, the most common surgical procedure for distal radius fractures in adults is volar plating with locking screws, but the specific procedure should be tailored to the individual patient. This is an important decision for athletes with stable fractures who desire to return to play but remains primarily based on the fracture severity and displacement, patient age, and the timing of the fracture relative to the sport season. Next, the determination of operative versus non-operative treatment must be made. First, the fracture must be stabilized and any secondary injuries evaluated. However, the overall principles in management remain the same. Perhaps because this group represents only 12.5% of adult distal radius fractures in adults, literature guiding their treatment is limited. The incidence of distal radius fracture is heightened in sports that risk high energy falls onto the hand or direct impact to the hand or wrist. Athletes in particular have better bone quality when compared to age-matched controls, but they typically sustain fractures after higher impact falls than those in the more sedentary population. The athlete presenting with a distal radius fracture tends to be both younger and healthier than the average patient presenting with a distal radius fracture. Distal radius fracture in young patients usually occurs in the setting of play or sports and accounts for 23% of all sports-related fractures in adolescents. In the older adult, osteoporosis and poor postural stability are associated with these fractures after falls onto an outstretched hand. ĭistal radius fractures occur in a bimodal distribution with the highest frequency in youths under the age of 18 and a secondary peak in adults over 50 years old. Worldwide, the incidence of distal radius fractures has increased over the past 40–50 years, almost doubling in certain populations. Distal radius fractures are the most common upper extremity fracture in patients in the USA, accounting for 0.7–2.5% of emergency department visits.
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