Many fractures of the distal radius require surgical treatment. The factors that determine whether or not surgery is indicated are things like the fragmentation of the bone, the instability of the fracture and its tendency to collapse, whether or not the joint is significantly affected with offset or gapping or disruption of the normal smooth surfaces. And any time there's an associated open soft tissue injury with exposure of the bone to the outside environment. All of these conditions require surgical attention. Surgery is typically performed either emergently if there's an open wound, or with a slight delay, after initial immobilization in a splint and referral to a hand surgeon. The surgeon will evaluate you, perform an examination, review your X-rays, and may wish to get further imaging studies such as a CT scan or an MRI in order to help in surgical planning. And then then the surgery is scheduled at a later date, usually within days to a couple of weeks after the initial injury. During that time, a brace is applied to the upper extremity to help control swelling and for comfort so that the fracture is not being aggravated with motion and use. There are a number of different operations performed to treat fractures of the distal radius and the wrist. There are minimally invasive procedures, which involve using some pins applied through the skin under X-ray guidance, all the way up to and including internal devices such as plates and screws or wires that are used in order to stabilize the fracture after it is brought back into its normal position. What determines how the fracture is best treated is a complex algorithm that is determined by the surgeon based on a number of different factors. Typically we try to use the least invasive procedure, if it's at all possible, and we go up the ladder going to more complex and more invasive procedures as needed to address different factors of the injury such as severe displacement or instability or loss of bone density.
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