[6] Distal Radius Fractures Flashcards
Where do fractures of the distal radius occur?
Through the distal metaphysis of the radius, with or without articular surface involvement
Why is the correct diagnosis and management of distal radius fractures crucial?
Because incorrect management may result on loss of normal wrist function, with significant implications on functional status and quality of life
What are the three most common distal radius fracture types?
- Colles’ fracture
- Smith’s fracture
- Bartons fracture
How are distal radius fractures most commonly caused?
FOOSH
Who is most likely to get distal radius fractures?
- Elderly (fragility fractures)
- Children between 5-15yrs
Why is the risk of distal radius fractures increased with age?
Due to osteoporosis
How does a FOOSH cause a distal radius fracture?
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
What % of all distal radius fractures are Colles’ fractures?
90%
What is a Colles’ fracture?
An extra-articular fracture of the distal radius with dorsal angulation and dorsal displacement, within 2cm of the articular surface
What does a Colles’ fracture typically occur due to?
Fragility fracture in osteoporotic bone
What is a Smith’s fracture?
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
What causes a Smith’s fracture?
Landing on the dorsal surface of the wrist
What is a Barton’s fracture?
An intra-articular fracture of the distal radius with associated dislocation of the radio-carpal joint
What can a Barton’s fracture be described as?
Volar (more common) or dorsal (less common), depending on whether the volar or dorsal rim of the radius is involved
What are the main risk factors for distal radius fractures?
- Increasing age
- Female
- Early menopause
- Smoking or alcohol excess
- Prolonged steroid use
What are the main risk factors for distal radius fractures related to?
Osteoporosis
How do patients with a distal radius fracture typically present?
Following an episode of acute trauma, complaining of immediate pain with or without deformity and sudden swelling around fracture site
What symptoms can neurological involvement lead to in distal radius fractures?
Paraesthesia or weakness
What is it important to assess on examination in distal radius fractures?
Any evidence of neurovascular compromise
What does checking for neurovascular compromise consist of in distal radius fractures?
- Check nerve function
- Check limb perfusion
What nerves should be included in the neurological examination for a suspected distal radius fracture?
- Median nerve
- Anterior interosseous nerve
- Ulnar nerve
- Radial nerve
How is the motor component of the median nerve assessed?
Abduction of the thumb
Where is the sensory component of the median nerve assessed?
Radial surface of distal 2nd digit
How is the anterior interosseous nerve assessed?
Opposition of the thumb and index finger
How is the motor component of the ulnar nerve assessed?
Adduction of the thumb
Where is the sensory component of the ulnar nerve assessed?
Ulnar surface of the distal 5th digit
How is the motor component of the radial nerve assessed?
Extension of the IPJ of thumb
Where is the sensory component of the radial nerve assessed?
Dorsal surface of 1st webspace
What are the differential diagnoses of distal radius fractures?
- Forearm fracture (such as Galeazzi or Monteggia fractures)
- Carpal bone fractures
- Tendonitis or tenosynovitis
- Wrist dislocation
What investigations can be done into distal radius fractures?
- Plain radiographs
- CT or MRI scanning
What is the advantage of plain radiographs in distal radius fractures?
They are the quickest and definitive investigations for most fractures
What measurements on plain radiographs help with the diagnosis of a distal radius fracture?
- Radial height <11cm
- Radial inclination <22 degrees
- Radial (volar) tilt >11 degrees
When might CT or MRI scanning be used in distal radius fractures?
In more complex distal radius fractures, particularly for operative planning
What is the priority in the immediate management of distal radius fractures?
Suitable resuscitation and stabilisation of the patient
What should happen to all displaced distal radius fractures once stabilised?
Closed reduction in the emergency department
What do all techniques for closed reduction of distal radius fractures involve?
Sufficient traction and manipulation under anaesthetic
What anaesthetic can be provided to reduce distal radius fractures?
Conscious sedation with haematoma block or Bier’s block
What should be done following reduction of a distal radius fracture?
The arm should be restricted to allow for bone healing
What further action is taken with stable and successfully reduced distal radius fractures?
They can typically be placed in a below-elbow backslab case, then radiographs repeated after 1 week to check for displacement
When do distal radius fractures require surgical intervention?
When they are significantly displaced or unstable
Why do significantly displaced or unstable distal radius fractures require surgical intervention?
As they have a risk of displacing over time
What are the options for surgical management of distal radius fractures?
- Open reduction and internal fixation
- K-wire fixation
- External fixation
What should be done once sufficient bone healing has occured?
Patients should be rehabilitated via physiotherapy to ensure the regaining of full function
What are the main complications following distal radius fractures?
- Malunion
- Median nerve compression
- Osteoarthritis
What happens in malunion in distal radius fractures?
Poor alignment leads to a shortened radius compared to ulnar
How can malunion be treated in distal radius fractures?
Corrective osteotomy
What does malunion in distal radius fractures lead to?
- Reduced wrist motion
- Wrist pain
- Reduced forearm rotation
Who is median nerve compression more common in with distal radius fractures?
Patients who heal in a significant degree of malunion
Which patients are more likely to get osteoarthritis from a distal radius fracture?
Those with intra-articular involvement from the original fracture
When is an intra-articular step of the radiocarpal joint advised to be surgically corrected?
When it is >2mm
