Evolution of concepts in the diagnosis and treatment of distal radius fractures (part I)

Fractures of the distal metaphyseal–epiphyseal region of the radius are among the most common injuries and have accompanied humankind throughout its history. The earliest descriptions of this type of injury are found in the works of Hippocrates, who interpreted it as a dislocation of the wrist joint. This opinion persisted for nearly two thousand years. Subsequently, the works of Galen, Palladius, Celsus, Duverney, and Fabricius contain detailed analyses of the direction of hand displacement and the associated impairment of finger function. Many clinical observations, anatomical dissections, and experimental studies conducted by the renowned surgeons of the past gradually dispelled this misconception. The priority in elucidating the true nature of this injury is most often given to Abraham Colles, whose name is associated with the most prevalent type of distal radius fracture. However, earlier attempts at accurate interpretation had also been recorded. Thus, at the beginning of the 18th century, Jean-Louis Petit noted that some wrist dislocations were actually fractures of the distal radius. The French surgeon Claude Pouteau was the first to clearly conclude that this injury represented a fracture rather than a dislocation. He explicitly pointed out the widespread diagnostic error. Undoubtedly, under the influence of the French surgery school, fundamental changes occurred in medical science in the early 19th century. Guillaume Dupuytren and his contemporaries made a substantial contribution to understanding the true mechanism, diagnosis, and treatment of distal radius fractures. The discovery of X-rays enabled clinicians to appreciate the diversity and complexity of these injuries. Although external immobilization remained the predominant treatment method for distal radial metaphyseal–epiphyseal fractures for many centuries, advances in internal fixation techniques over recent decades have led to substantial success in their management. This article presents a historical review of evolving concepts in the diagnosis and treatment of patients with distal metaphyseal–epiphyseal fractures of the radius, from ancient times up to the discovery of X-rays.