INTRA-ARTICULAR FRACTURES OF THE DISTAL RADIUS BY DAVID RING, MD Intra-articular fractures of the distal radius are more challenging to treat than extra-articular fractures. Optimal treatment is achieved when the pattern of injury is recognized and its component parts are adequately addressed. The importance of the final articular surface alignment has received substantial emphasis, but extra-articular alignment, the overall complexity of the injury, associated injuries, and complications are also very important determinants of the final functional result. No single implant or technique is appropriate for all fractures and surgeons should be familiar with a variety of options. Copyright © 2002 by the American Society for Surgery of the Hand D isplaced fractures of the articular surface of the distal radius have a worse prognosis than extra-articular fractures because of the poten- tial for incongruity and arthrosis of the radiocarpal and distal radioulnar joints, carpal subluxation, and associated intercarpal ligament injuries. Surgical stabilization of distal radial articular fragments is hindered by close association of the fragments with surrounding ligaments and tendons, metaphyseal comminution and poor bone quality, the potential for digit swelling and nerve dysfunction, and complica- tions associated with implants. Articular fractures of the distal radius occur in basic patterns, each of which has specific pitfalls. Although treatment of these in- juries has improved over the past few decades, the continued expansion in the variety of implants and techniques for treating fractures of the distal radius reflects not only technical advances, but also the draw- backs of existing techniques and lack of consensus. ANATOMY T he articular surface facing the carpus is split into distinct facets that articulate with the scaphoid and lunate. The basic compressive articular fracture line usually occurs between these facets. Additional compressive force will split the fragments in the coro- nal plane or cause central fragmentation and impac- tion. The alignment of unstable displaced fragments is affected by soft-tissue attachments. 1 The triangular fibrocartilage complex (TFCC) attaches to the ulnar margin of the lunate facet. The volar and dorsal mar- gins of the complex (radioulnar ligaments) can con- tribute to malrotation of lunate facet fragments. Stout radiocarpal ligaments attach to the volar margin of the distal radial articular surface and tend to pull it dis- From the Harvard Medical School, Hand and Upper Extremity Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA. Address reprint requests to David Ring, MD, Instructor of Ortho- paedic Surgery, Harvard Medical School, Hand and Upper Extremity Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, ACC 527, 15 Parkman St, Boston, MA 02114. E-mail: dring@partners.org Copyright © 2002 by the American Society for Surgery of the Hand 1531-0914/02/0202-0005$35.00/0 doi:10.1053/jssh.2002.33322 60 JOURNAL OF THE AMERICAN SOCIETY FOR SURGERY OF THE HAND  VOL. 2, NO. 2, MAY 2002