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Comprehensive Management of Distal End Radius Fractures in Adults: A Clinical Review and Decision-Making Approach

April 10, 2026/in January-June 2026 | Volume 12 | Issue 1

Review Article | Vol 12 | Issue 1 | January-June 2026 | page: 25-30 | Sachin Kale, Altaf Warid, Gaurav Sharma, Ashok Shyam, Ashok Ghodke, Nikhil Makhija DOI: https://doi.org/10.13107/ti.2026.v12.i01.82 Submitted: 07/01/2026; Reviewed: 02/02/2026; Accepted: 06/03/2026; Published: 10/04/2026 Authors: Sachin Kale [1], Altaf Warid [1], Gaurav Sharma [1], Ashok Shyam [1], Ashok Ghodke [1], Nikhil Makhija […]

Fixation Modalities for Medial Void in Distal Femur Fractures: A Narrative Review

April 10, 2026/in January-June 2026 | Volume 12 | Issue 1

Review Article | Vol 12 | Issue 1 | January-June 2026 | page: 21-24 | Sachin Kale, Ashok Ghodke, Tejaswini Milind Patankar, Gaurav Kanade, Abhilash Srivastava, Sagar Deshpande DOI: https://doi.org/10.13107/ti.2026.v12.i01.80 Submitted: 09/02/2026; Reviewed: 04/03/2026; Accepted: 21/03/2026; Published: 10/04/2026 Authors: Sachin Kale [1], Ashok Ghodke [2], Tejaswini Milind Patankar [2], Gaurav Kanade [1], Abhilash Srivastava [1], […]

Comprehensive Management of Distal End Radius Fractures in Adults: A Clinical Review and Decision-Making Approach

April 10, 2026/in January-June 2026 | Volume 12 | Issue 1

Fixation Modalities for Medial Void in Distal Femur Fractures: A Narrative Review

April 10, 2026/in January-June 2026 | Volume 12 | Issue 1

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Comprehensive Management of Distal End Radius Fractures in Adults: A Clinical Review and Decision-Making Approach

April 10, 2026/in January-June 2026 | Volume 12 | Issue 1

DOI: https://doi.org/10.13107/ti.2026.v12.i01.82

Submitted: 07/01/2026; Reviewed: 02/02/2026; Accepted: 06/03/2026; Published: 10/04/2026

Authors: Sachin Kale [1], Altaf Warid [1], Gaurav Sharma [1], Ashok Shyam [1], Ashok Ghodke [1], Nikhil Makhija [1]

[1] Department of Orthopaedics, Dr. D.Y. Patil Medical College, Navi Mumbai, Maharashtra, India.

Address of Correspondence

Dr. Sachin Kale,

Department of Orthopaedics, Dr. D.Y. Patil Medical College, Navi Mumbai, Maharashtra, India.

E-mail: sachinkale@gmail.com

Abstract

Background: Distal radius fractures represent one of the most frequently encountered injuries in orthopaedic practice worldwide, accounting for a significant proportion of upper limb fractures across all age groups. These fractures demonstrate a bimodal distribution, occurring commonly in young individuals following high-energy trauma and in elderly osteoporotic patients after low-energy falls. Over the past few decades, the management of distal radius fractures has undergone substantial evolution, driven by advancements in imaging modalities such as computed tomography, a deeper understanding of wrist biomechanics, and the development of improved fixation techniques. These advances have enabled more precise fracture characterization and have contributed to better functional restoration.

Objectives: This review aims to provide a comprehensive yet practical overview of distal radius fractures, with particular emphasis on systematic clinical evaluation, commonly used classification systems, and contemporary evidence-based management strategies. The goal is to aid clinicians in making informed decisions tailored to individual patient and fracture characteristics.

Methods: A narrative review was conducted using standard orthopaedic textbooks, peer-reviewed journal articles, and widely accepted clinical guidelines. Relevant literature focusing on epidemiology, fracture classification (including commonly used systems such as Frykman, Fernandez, and AO/OTA), imaging modalities, and both conservative and surgical management approaches was analyzed to synthesize current best practices.

Results: The management approach to distal radius fractures largely depends on fracture stability, displacement, intra-articular involvement, and patient-related factors such as age, bone quality, functional demands, and comorbidities. Stable, extra-articular fractures with acceptable alignment generally respond well to conservative treatment, including immobilization with casting. However, unstable fractures—characterized by dorsal comminution, significant displacement, loss of radial height or inclination, and intra-articular extension—are associated with a higher risk of malunion and functional impairment when treated non-operatively. Surgical intervention in such cases has been shown to provide superior anatomical reduction and improved functional outcomes. Among surgical options, volar locking plate fixation has gained widespread acceptance due to its biomechanical stability, ability to maintain reduction in osteoporotic bone, and facilitation of early mobilization. Other modalities, including external fixation, percutaneous pinning, and dorsal plating, remain relevant in selected scenarios.

Conclusion: The management of distal radius fractures should be individualized, considering both fracture-specific characteristics and patient-related factors. A thorough clinical and radiological assessment is essential for optimal decision-making. Modern fixation techniques, particularly volar locking plates, have significantly enhanced the ability to achieve stable fixation and early functional recovery. Nevertheless, careful patient selection and adherence to sound surgical principles remain critical to achieving favorable outcomes.

Keywords: AO Classification, Distal End Radius Fractures, Volar Plating, Decision Making

References

Shehovych A, Salar O, Meyer C, Ford DJ. Adult distal radius fractures classification systems: essential clinical knowledge or abstract memory testing? Ann R Coll Surg Engl. 2016;98(8):525–531.
Kale SY, Ahire P, Altaf W, Shyam A, Sharma G. Beginner’s Guide for Management of Distal End Radius Fractures in Adults. Navi Mumbai: DY Patil University; 2024.
Colles A. On the fracture of the carpal extremity of the radius. Edinburgh Med Surg J. 1814;10:182–186.
Fernandez DL. Fractures of the distal radius: operative treatment. Instr Course Lect. 1993;42:73–88.
Melone CP Jr. Articular fractures of the distal radius. Orthop Clin North Am. 1984;15(2):217–236.
Rikli DA, Regazzoni P. Internal fixation of distal radius fractures. J Bone Joint Surg Br. 1996;78(4):588–592.
Jupiter JB, Fernandez DL. Comparative classification for fractures of the distal end of the radius. J Hand Surg Am. 1997;22(4):563–571.
Chung KC, Shauver MJ, Birkmeyer JD. Trends in the United States in the treatment of distal radial fractures in the elderly. J Bone Joint Surg Am. 2009;91(8):1868–1873.
Orbay JL, Fernandez DL. Volar fixation for dorsally displaced fractures of the distal radius: a preliminary report. J Hand Surg Am. 2002;27(2):205–215.
Arora R, Lutz M, Deml C, Krappinger D, Haug L, Gabl M. A prospective randomized trial comparing nonoperative treatment with volar locking plate fixation for displaced and unstable distal radial fractures in patients ≥65 years. J Bone Joint Surg Am. 2011;93(23):2146–2153.
Handoll HHG, Madhok R. Surgical interventions for treating distal radial fractures in adults. Cochrane Database Syst Rev. 2003;(3):CD003209.
Diaz-Garcia RJ, Chung KC. Common myths and evidence in the management of distal radius fractures. Hand Clin. 2012;28(2):127–133.
Margaliot Z, Haase SC, Kotsis SV, Kim HM, Chung KC. A meta-analysis of outcomes of external fixation versus plate osteosynthesis for unstable distal radius fractures. J Hand Surg Am. 2005;30(6):1185–1199.
Wei DH, Raizman NM, Bottino CJ, Jobin CM, Strauch RJ, Rosenwasser MP. Unstable distal radial fractures treated with external fixation, a radial column plate, or a volar plate: a prospective randomized trial. J Bone Joint Surg Am. 2009;91(7):1568–1577.
Nellans KW, Kowalski E, Chung KC. The epidemiology of distal radius fractures. Hand Clin. 2012;28(2):113–125.

How to Cite this article: Kale S, Warid A, Sharma G, Shyam A, Ghodke A, Makhija N | Comprehensive Management of Distal End Radius Fractures in Adults: A Clinical Review and Decision-Making Approach | January-June 2026; 12(1): 25-30 | https://doi.org/10.13107/ti.2026.v12.i01.82

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Fixation Modalities for Medial Void in Distal Femur Fractures: A Narrative Review

April 10, 2026/in January-June 2026 | Volume 12 | Issue 1

DOI: https://doi.org/10.13107/ti.2026.v12.i01.80

Submitted: 09/02/2026; Reviewed: 04/03/2026; Accepted: 21/03/2026; Published: 10/04/2026

Authors: Sachin Kale [1], Ashok Ghodke [2], Tejaswini Milind Patankar [2], Gaurav Kanade [1], Abhilash Srivastava [1], Sagar Deshpande [3]

[1] Department of Orthopaedics, Dr. D.Y. Patil Medical College, Navi Mumbai, Maharashtra, India.

[2] Department of Orthopaedics, M G M Medical College Kamote Navi Mumbai, Maharashtra, India

[3] Department of Physiotherapy, Dr. D.Y. Patil Medical College, Navi Mumbai, Maharashtra, India.

Address of Correspondence

Dr. Sachin Kale;

Department of Orthopaedics, Dr. D.Y. Patil Medical College, Navi Mumbai, Maharashtra, India.

E-mail: sachinkale@gmail.com

Abstract

Medial void in distal femur fractures—resulting from metaphyseal comminution, cortical bone loss, or segmental defects—predisposes constructs to varus collapse, non-union, and hardware failure if left unsupported. This narrative review synthesises current fixation strategies to address the medial defect, including: (1) lateral locked plating with augmentation (subchondral rafting, kickstand/medial column screws, bone graft and substitutes, and cement augmentation), (2) dual plating with a medial buttress, (3) nail–plate combination constructs, and (4) emerging concepts such as far cortical locking and linked constructs. Across biomechanical and clinical studies, strategies that restore a medial buttress or create a stable load-sharing environment reduce varus collapse, improve radiographic parameters, and may shorten time to union in comminuted, osteoporotic, or peri‑articular patterns. Technique selection should be individualised by patient factors (bone quality, soft tissue, comorbidities), fracture morphology (AO/OTA 33‑A3/C3, periprosthetic, non‑union), and intra‑operative reduction behaviour. We propose a pragmatic, reduction‑first algorithm prioritising medial column support, balanced construct flexibility, adequate working length, and biological preservation. Future work should include comparative trials of dual plating versus nail–plate constructs with standardised indications and patient‑reported outcomes.

Keywords: Distal femur fracture, Medial void, Dual plating, Nail–plate construct, Cement augmentation, Far cortical locking, Kickstand screw

References

1. Kregor PJ, Stannard JA, Zlowodzki M, Cole PA. Treatment of distal femur fractures using the Less Invasive Stabilization System (LISS): early clinical results. J Orthop Trauma. 2004;18(8):509–520.

2. Schütz M, Müller M, Krettek C, Hontzsch D, Regazzoni P, Ganz R, et al. Minimally invasive fracture stabilisation of distal femoral fractures with the LISS: technique and early results. Injury. 2001;32(Suppl 3):SC32–SC47.

3. Ricci WM, Streubel PN, Morshed S, Collinge CA, Nork SE, Gardner MJ. Risk factors for failure of locked plate fixation of distal femur fractures: an analysis of 335 cases. J Orthop Trauma. 2014;28(2):83–89.

4. Tripathy SK, Goyal T, Sen RK, et al. Dual‑Plating in distal femur fracture: a systematic review. Cureus. 2021;13(1):e12685.

5. Thorne TJ, Arrington ED. Dual plating of distal femoral fractures. JBJS Rev. 2024;12(6):e23.00247.

6. Kook I, et al. The impact of medial‑first dual plating for reduction of distal femur fractures. Sci Rep. 2025;15.

7. Leal JA, et al. Medial augmentation of distal femur fractures using the contralateral lateral distal femoral locking plate. OTA Int. 2024;7(3):e335.

8. Chen SR, Shaikh H, Turvey BR, et al. Supplemental medial column screw fixation of distal femur fractures treated with a laterally based locked plate: technical trick. J Orthop Trauma. 2023;37:e175–e180.

9. Henningsen J, et al. Increased stiffness with medial column screw in distal femur fracture models: a biomechanical study. Injury. 2025.

10. Dimitroulias A, et al. Linking a nail and a plate for distal femur fractures. SICOT‑J. 2024;10:8.

11. Liporace FA, Yoon RS. Distal femur: nail–plate combination and the linked construct. OTA Int. 2022;5(3):e200.

12. Saraglis G, et al. Linked nail/plate construct for complex distal femur fractures: effectiveness and union. SICOT‑J. 2024;10:20.

13. Baumann AN, et al. Nail‑plate combination constructs versus single traditional constructs for distal femur fractures: comparative outcomes. Injury. 2024.

14. Xu W, et al. Comparison of retrograde nail plus lateral plate versus dual plating in AO/OTA 33C distal femur fractures: a retrospective cohort. Sci Rep. 2025;15.

15. Bäumlein M, et al. Cement augmentation of angular stable plate fixation in distal femur: biomechanical effects of fenestrated condylar screws. BMC Musculoskelet Disord. 2020;21:282.

16. Wähnert D, et al. Implant augmentation in the treatment of distal femoral fractures: a biomechanical investigation. Injury. 2013;44(6):785–789.

17. DeBaun MR, et al. Calcium phosphate cement and locked plate augmentation of large distal femoral defects: comparative study. Knee. 2019;26(5):1040–1048.

18. Bottlang M, Doornink J, Fitzpatrick DC, et al. Far cortical locking enables flexible fixation with periarticular locking plates. Clin Orthop Relat Res. 2011;469:1757–1765.

19. Bottlang M, et al. Dynamic fixation of distal femur fractures using far cortical locking screws: prospective observational study. J Orthop Trauma. 2014;28(12):e276–e283.

20. Stockton DJ. Distal Femur Fractures—OTA Core Curriculum; selected readings and references (includes Ricci et al.). 2021.

How to Cite this article: Kale S, Srivastava A, Deore S, Yadav A, Kushdeep, Datta S | The Three-Stitch Technique for Antegrade Humerus Nailing: A Minimally Invasive Approach to Improved Functional Outcomes and Reduced Complications in Humerus Shaft Fractures Narrative review | January-June 2026; 12(1): 15-20 | https://doi.org/10.13107/ti.2026.v12.i01.78

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Half Sized Blog Element (Multi Author Style)

Comprehensive Management of Distal End Radius Fractures in Adults: A Clinical Review and Decision-Making Approach

Fixation Modalities for Medial Void in Distal Femur Fractures: A Narrative Review

Comprehensive Management of Distal End Radius Fractures in Adults: A Clinical Review and Decision-Making Approach

Fixation Modalities for Medial Void in Distal Femur Fractures: A Narrative Review

Full Sized Blog Element (Big Preview Pic)

Comprehensive Management of Distal End Radius Fractures in Adults: A Clinical Review and Decision-Making Approach

Authors: Sachin Kale [1], Altaf Warid [1], Gaurav Sharma [1], Ashok Shyam [1], Ashok Ghodke [1], Nikhil Makhija [1]

Abstract

References

(Abstract Text HTML) (Download PDF)

Fixation Modalities for Medial Void in Distal Femur Fractures: A Narrative Review

Authors: Sachin Kale [1], Ashok Ghodke [2], Tejaswini Milind Patankar [2], Gaurav Kanade [1], Abhilash Srivastava [1], Sagar Deshpande [3]

Abstract

References

(Abstract Text HTML) (Download PDF)

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