Fractures and Injuries of the Distal Radius and Carpus: The Cutting Edge

Fractures of the Distal Radius and Carpus: The Cutting Edge is a useful addition to the literature. The book is well written and provides excellent discussion of standard techniques and newer state-of-the-art procedures. The authors are well known in the field and have a broad expertise. The book has 57 chapters divided into 8 parts, plus an additional 9 Web chapters and 41 Web videos. The reader is able to access the Web material using a special code provided at the beginning of the book.

Parts 1 through 5 (chapters 1-24) are devoted to fractures of the distal radius. The treatment of this topic is comprehensive. Chapters are devoted to evaluation, imaging, and surgical approaches. The older techniques of fixation, including percutaneous pinning, external fixation, and dorsal plating, are discussed. Newer techniques of volar plating, intramedullary fixation, arthroscopy-assisted fixation, and fragment-specific fixation are also discussed in detail. Volar locking plate fixation has become popular, and a chapter by Nelson on complications of volar locking plates is timely and informative. The chapter by Hartigan and Makowiec on the numerous available bone-graft substitutes can help the practicing surgeon make sense of the options. The chapter on complex regional pain syndrome is an excellent review and will be exceptionally useful to hand surgeons.

Although there are a number of seemingly wonderful techniques for fixation of distal radius fractures, the literature has not substantiated many of these techniques. The review of this literature in chapter 5, “Predicting the Outcome of Distal Radius Fractures,” is rather cursory. The point is made that loss of reduction or poor reduction has been associated with the development of arthritis. This of course has been the rationale for operating on many radius fractures. However, the literature does not convincingly prove that the development of arthritis necessarily leads to a poor result—a point critical in decision making. Although factors such as osteoporosis, degree of comminution, and accuracy of reduction are clearly important, the method and type of fixation likewise has a bearing on the final result. The book presents excellent discussions of varied techniques but no discussion defining which techniques may be preferred for certain fracture patterns or comorbid disorders such as osteoporosis.

Part 6 (chapters 25-37), on the ulnar side of the wrist, is exceptionally well executed and comprehensive. Excellent chapters cover ulnar shortening osteotomy, wafer resection, and Sauve-Kapandji hemiresection interposition arthroplasty. Chapters on ulnar head implantation and distal radioulnar joint prostheses are superbly illustrated and complete.

The chapter by Kleinman on stability of the distal radioulnar joint is an exceptionally thoughtful discussion of the ligaments of this joint. The importance of the ligamentum subcruetum and tensioning of the ligament associated with forearm rotation is explained and superbly illustrated. The “Anatomy and Biomechanics of Forearm Rotation” chapter provides a complete discussion of this topic, both in normal function and following injury.

Part 7, “Carpal Ligament Injury,” emphasizes the ligamentous structures of the wrist and carpal instability. The chapters explaining the biomechanics of the carpal bones are well written and informative. A number of approaches for ligamentous instability of the wrist are described in detail. These include dorsal capsulodesis and bone-ligament-bone reconstruction. Fractures of the scaphoid are a common fracture of the wrist (second most common after distal radius fractures); one chapter does discuss scaphoid fractures associated with distal radius fractures, but it is unclear why there is no formal discussion of treatment of carpus fractures. Carpal instability is covered in depth, even though scaphoid fractures (and nonunions) are a much more common problem.

Part 8 comprises 6 chapters that discuss complications. These useful and pragmatic chapters cover topics frequently omitted by other texts. The chapter by Garcia-Elias on the loss of pronosupination of the wrist is superb and discusses both the pathology and a logical plan of treatment. The chapter by Fernandez—one of the world's most experienced wrist surgeons—on correction of distal radius malunion is a masterpiece.

The Web chapters are a useful addition and cover a diverse number of topics, including arthroscopic treatment of wrist instability and reconstruction with a free osteochondral graft. The Web-based videos are for the most part informative and useful. Numerous procedures are demonstrated, some in a cadaver laboratory and others in live surgery.

Much of this material is truly cutting edge. As is the case with many new procedures, no strong randomized or even retrospective studies have been conducted to prove the validity of these procedures. This is to be expected, and surgeons must use their judgment and knowledge to decide which procedure is most appropriate for a given patient. Fractures and Injuries of the Distal Radius and Carpus is geared for the trainee as well as the practicing surgeon. The editors are to be congratulated for assembling an all-star cast for this effort, one of the most complete and up-to-date books on this topic.