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4/3: Elderly/Orthopaedics Y3/4 - MSK [11] (check ILOs) > [6] Distal Radius Fractures > Flashcards

[6] Distal Radius Fractures Flashcards

1
Q

Where do fractures of the distal radius occur?

A

Through the distal metaphysis of the radius, with or without articular surface involvement

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2
Q

Why is the correct diagnosis and management of distal radius fractures crucial?

A

Because incorrect management may result on loss of normal wrist function, with significant implications on functional status and quality of life

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3
Q

What are the three most common distal radius fracture types?

A
  • Colles’ fracture
  • Smith’s fracture
  • Bartons fracture
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4
Q

How are distal radius fractures most commonly caused?

A

FOOSH

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5
Q

Who is most likely to get distal radius fractures?

A
  • Elderly (fragility fractures)
  • Children between 5-15yrs
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6
Q

Why is the risk of distal radius fractures increased with age?

A

Due to osteoporosis

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7
Q

How does a FOOSH cause a distal radius fracture?

A

The distal radius takes 80% of the axial load underneath the scaphoid and lunate fossae. A FOOSH causes forced extension or flexion of the carpus, which in turn increases the impaction load of the distal radius

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8
Q

What % of all distal radius fractures are Colles’ fractures?

A

90%

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9
Q

What is a Colles’ fracture?

A

An extra-articular fracture of the distal radius with dorsal angulation and dorsal displacement, within 2cm of the articular surface

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10
Q

What does a Colles’ fracture typically occur due to?

A

Fragility fracture in osteoporotic bone

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11
Q

What is a Smith’s fracture?

A

When there is volar angulation of the distal fragment of an extra-articular fracture of the distal radius (the opposite of a Colles fracture), with or without volar displacement

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12
Q

What causes a Smith’s fracture?

A

Landing on the dorsal surface of the wrist

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13
Q

What is a Barton’s fracture?

A

An intra-articular fracture of the distal radius with associated dislocation of the radio-carpal joint

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14
Q

What can a Barton’s fracture be described as?

A

Volar (more common) or dorsal (less common), depending on whether the volar or dorsal rim of the radius is involved

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15
Q

What are the main risk factors for distal radius fractures?

A
  • Increasing age
  • Female
  • Early menopause
  • Smoking or alcohol excess
  • Prolonged steroid use
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16
Q

What are the main risk factors for distal radius fractures related to?

A

Osteoporosis

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17
Q

How do patients with a distal radius fracture typically present?

A

Following an episode of acute trauma, complaining of immediate pain with or without deformity and sudden swelling around fracture site

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18
Q

What symptoms can neurological involvement lead to in distal radius fractures?

A

Paraesthesia or weakness

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19
Q

What is it important to assess on examination in distal radius fractures?

A

Any evidence of neurovascular compromise

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20
Q

What does checking for neurovascular compromise consist of in distal radius fractures?

A
  • Check nerve function
  • Check limb perfusion
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21
Q

What nerves should be included in the neurological examination for a suspected distal radius fracture?

A
  • Median nerve
  • Anterior interosseous nerve
  • Ulnar nerve
  • Radial nerve
22
Q

How is the motor component of the median nerve assessed?

A

Abduction of the thumb

23
Q

Where is the sensory component of the median nerve assessed?

A

Radial surface of distal 2nd digit

24
Q

How is the anterior interosseous nerve assessed?

A

Opposition of the thumb and index finger

25
Q

How is the motor component of the ulnar nerve assessed?

A

Adduction of the thumb

26
Q

Where is the sensory component of the ulnar nerve assessed?

A

Ulnar surface of the distal 5th digit

27
Q

How is the motor component of the radial nerve assessed?

A

Extension of the IPJ of thumb

28
Q

Where is the sensory component of the radial nerve assessed?

A

Dorsal surface of 1st webspace

29
Q

What are the differential diagnoses of distal radius fractures?

A
  • Forearm fracture (such as Galeazzi or Monteggia fractures)
  • Carpal bone fractures
  • Tendonitis or tenosynovitis
  • Wrist dislocation
30
Q

What investigations can be done into distal radius fractures?

A
  • Plain radiographs
  • CT or MRI scanning
31
Q

What is the advantage of plain radiographs in distal radius fractures?

A

They are the quickest and definitive investigations for most fractures

32
Q

What measurements on plain radiographs help with the diagnosis of a distal radius fracture?

A
  • Radial height <11cm
  • Radial inclination <22 degrees
  • Radial (volar) tilt >11 degrees
33
Q

When might CT or MRI scanning be used in distal radius fractures?

A

In more complex distal radius fractures, particularly for operative planning

34
Q

What is the priority in the immediate management of distal radius fractures?

A

Suitable resuscitation and stabilisation of the patient

35
Q

What should happen to all displaced distal radius fractures once stabilised?

A

Closed reduction in the emergency department

36
Q

What do all techniques for closed reduction of distal radius fractures involve?

A

Sufficient traction and manipulation under anaesthetic

37
Q

What anaesthetic can be provided to reduce distal radius fractures?

A

Conscious sedation with haematoma block or Bier’s block

38
Q

What should be done following reduction of a distal radius fracture?

A

The arm should be restricted to allow for bone healing

39
Q

What further action is taken with stable and successfully reduced distal radius fractures?

A

They can typically be placed in a below-elbow backslab case, then radiographs repeated after 1 week to check for displacement

40
Q

When do distal radius fractures require surgical intervention?

A

When they are significantly displaced or unstable

41
Q

Why do significantly displaced or unstable distal radius fractures require surgical intervention?

A

As they have a risk of displacing over time

42
Q

What are the options for surgical management of distal radius fractures?

A
  • Open reduction and internal fixation
  • K-wire fixation
  • External fixation
43
Q

What should be done once sufficient bone healing has occured?

A

Patients should be rehabilitated via physiotherapy to ensure the regaining of full function

44
Q

What are the main complications following distal radius fractures?

A
  • Malunion
  • Median nerve compression
  • Osteoarthritis
45
Q

What happens in malunion in distal radius fractures?

A

Poor alignment leads to a shortened radius compared to ulnar

46
Q

How can malunion be treated in distal radius fractures?

A

Corrective osteotomy

47
Q

What does malunion in distal radius fractures lead to?

A
  • Reduced wrist motion
  • Wrist pain
  • Reduced forearm rotation
48
Q

Who is median nerve compression more common in with distal radius fractures?

A

Patients who heal in a significant degree of malunion

49
Q

Which patients are more likely to get osteoarthritis from a distal radius fracture?

A

Those with intra-articular involvement from the original fracture

50
Q

When is an intra-articular step of the radiocarpal joint advised to be surgically corrected?

A

When it is >2mm

4/3: Elderly/Orthopaedics Y3/4 - MSK [11] (check ILOs) (38 decks)

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