Question
A 68 year old woman falls onto her outstretched hand and has a dinner fork deformity of the wrist.
- Which radiological parameters guide management?
- What are the treatment options?
- What have trials shown in older patients?
Answer
Radiological parameters
| Parameter | Normal | Acceptable after reduction |
|---|---|---|
| Radial height | 11 mm | Shortening under 3 mm |
| Radial inclination | 22 degrees | At least 15 degrees |
| Volar tilt | 11 degrees | Dorsal tilt under 10 degrees |
| Articular step | None | Under 2 mm |
Options
- Closed reduction and cast
- Volar locking plate
- K wires
- Bridging external fixation or dorsal bridge plate for severe comminution
- Ulnar styloid fractures rarely need fixation
- Volar plating can cause flexor or EPL tendon rupture
Trials
- DRAFFT found similar function at 12 months with K wires and volar plates
- CROSSFIRE found similar wrist function at 12 months with plating or casting in patients over 60
- Radiographic malunion is better tolerated in low demand older patients
- Watch for acute carpal tunnel syndrome after injury and reduction
Related pages
Author Contributions
Orthofracs team
Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.