Distal radius fractures (DRFs) are one of the most common injuries in orthopaedics,accounting for up to 20％ of all fractures seen in the emergency room.At present,the optimal treatment of these fractures remains controversial.Although most DRFs can be treated non-operatively,such as immobilized by plaster,splint or brace,surgical management has become more and more popular with people's living standards improved and expecting better functional outcome.Surgical treatments for DRFs include percutaneous fixation with Kirschner wires,skeletal external fixation,open reduction and internal fixation,intramedullary nails,fixation using the mini-invasive approach,arthroscopy,and total wrist arthroplasty.Currently,open reduction with volar plate fixation is the most popular and widely way for DRFs,while a mini-invasive approach is a new reliable and reproducible procedure with few complications.Despite recently surgical treatment has become more and more popular,it is also unclear whether surgical intervention will produce better long-term outcomes.The aim of this paper is to present the studies in the literatures about the treatment for DRFs and an update of existing techniques.

Ulnar styloid fractures are commonly associated with distal radius fractures.It remains a surgical dilemma whether to fix the ulnar styloid or not.Some surgeons believe that management of the ulnar styloid fractures is imperative while others feel that they should be managed conservatively.Several clinical studies have concluded that the ulnar styloid fractures have no impact on the anatomic,radiographic,or functional results when accompanied with a distal radius fracture.Others have found they are associated with distal radioulnar joint (DRUJ) instability,concomitant triangular fibrocartilage complex (TFCC) tear,decreased range of motion,or decreased grip strength in the affected wrist.The purpose of this review was to evaluate the effect of associated ulnar styloid fractures on the distal radius fractures and to discuss the treatment of ulnar styloid fractures.

Objective To compare the clinical outcomes between proximal femoral nail antirotation (PFNA) combined with zoledronic acid and PFNA only in the treatment of osteoporotic intertrochanteric fracture in the elderly patients.Methods A retrospective analysis was made on 72 patients that completed the follow-up after PFNA for osteoporotic intertrochanteric fracture from November 2011 to May 2014.According to the application of zoledronic acid (5 mg,once a year) after PFNA,the patients were divided into study group (n =30) and control group (n =42).Bone healing and subsequent refracture were assessed with X-ray postoperatively.Harris hip score was recorded.Bone mineral density before operation and one year after operation were compared between the two groups.Adverse effect of zoledronic acid was recorded during hospitalization.Results Mean period of follow-up was 15 months (range,12-26 months).One year after operation,Harris score,new fracture incidence,mean fracture union time were (82.65 ± 6.24) points,3％ (1/30) and (14.26-± 2.24) weeks in study group,while (81.85 ± 5.38) points,14％ (6/42) and (15.26 ± 3.05) weeks in control group.There were no statistical differences between the two groups (P ＞ 0.05),but the subsequent fracture was higher in control group.One year after operation,lumbar and contralateral non-injury hip bone marrow density were (0.78 ± 0.16)g/cm2 and (0.71 ± 0.14)g/cm2 in study group,higher than (0.75 ± 0.13)g/cm2 and (0.69 ±0.13)g/cm2 in control group (P ＜0.05).But there were no significant differences between the two groups before operation.All fractures were healed at postoperative 1 year.No intolerable adverse events occurred in study group.Conclusions PFNA is effective in the treatment of osteoporotic intertrochanteric fracture.In the meantime,the combination with zoledronic acid has no influence on bone healing while increasing bone mineral density,and may decrease the occurrence of subsequent fragile fractures.