Partial Wrist Denervation in Comminuted Articular Distal Radius Fractures

Distal radius fractures represent the most common fractures in adults showing an overall prevalence of 17.5 % with respect to all fractures. partial wrist denervation is an adjunctive procedure performed during initial fracture fixation to mitigate chronic pain by interrupting sensory innervation to the wrist joint. It targets the anterior interosseous nerve (AIN) and posterior interosseous nerve (PIN), which convey nociceptive signals from the radiocarpal and midcarpal joints.

Comminuted intra-articular distal radius fractures (AO/OTA Type C2/C3) often lead to post-traumatic arthritis due to articular incongruity and capsular damage. Denervation at the index procedure may reduce central sensitization and chronic pain by resecting afferent pain fibers, potentially improving postoperative rehabilitation and functional outcomes.

Acute comminuted intra-articular distal radius fractures (AO/OTA C2/C3) with high risk of post-traumatic arthritis (e.g., articular step-off >2 mm, severe fragmentation).

• Active individuals seeking motion preservation, those with high functional demands (e.g., athletes, laborers), or patients preferring a less invasive option than salvage procedures.
• Adjunct to primary fixation: Performed concurrently with volar locking plate (VLP) or dorsal plating.

Inclusion criteria

• Age from 18

• Fracture Pattern: Acute, comminuted intra-articular distal radius fractures (AO/OTA Type C2 or C3).
• Surgical Context: Procedure performed as a primary adjunct during initial open reduction and internal fixation (ORIF).

Exclusion criteria

Active local infection over the surgical site.

• Compromised soft tissue envelope that precludes safe dissection.
• Vascular injury or compromise requiring repair.
• Pre-existing neurological deficit (e.g., complex regional pain syndrome, major peripheral nerve injury).