Fracture of distal radius——The Melone Classificatio

Fractures of the distal radius have many types and classifications. These classifications include: Fernandez, Frykman, Melone, Three Column Theory, and AO. Each type will require a specific understanding of the classification and management of the fractures (not all of them can be treated with a cast).

In the Melone Classification of distal radius fractures, there are five types of intra-articular fractures divided into fracture types based on displacement. Based on the effect of the lunate’s impaction on the radial articular surface to create characteristic fracture fragments.

Type I fractures are stable and without displacement. Type I fractures results in four characteristic fragments: the radial shaft fragment proximal to the fracture, radial styloid fragment, dorsal fragment of the lunate facet, and the palmar fragment of the lunate facet.

Type II fractures are an unstable “Die punch” displaced intra-articular fracture. Type II A fractures are reducible. Type II B fractures are irreducible (central impaction fracture) and double die-punch fractures usually require an open reduction and internal fixation.

Type III fractures are also referred to as “Spike fractures”. These are unstable die punch fractures with displacement of the articular surface and also of the proximal spike of the radius. These fractures involve additional fracture fragments from the shaft of the radius that projects into flexor compartment (may involve the median nerve). These fractures usually require surgery in order to remove the spike and fix the fracture.

Type IV fractures are also known as a “Split fracture”. These are unstable fractures of the medial complex that is severely comminuted with separation and/or rotation of the dorsal and palmar fragments.

Type V fractures are referred to as an “explosion injury”. These injuries are severe comminution and major soft tissue injuries.