Colles / Smiths / Bartons Wrist Fractures

Question 1

What are the risk factors for Distal Radius #s? (5 things)

Answer 1

1. Age
2. Female
3. Early menopause
4. Smoking / alcohol
5. Prolonged steroid use

All related to osteoporosis

Question 2

What are the types of Distal Radius #s? (3 things)

Answer 2

1. Colles
2. Smiths
3. Bartons

Question 3

What are the features of a Colles #? (3 things)

Answer 3

1. Dorsal displacement (dinner fork)
2. Extra-articular # (not part of articulating joint)
3. Caused by FOOSH

Question 4

What are the features of a Smiths #? (3 things)

Answer 4

1. Volar displacement
2. Extra-articular #
3. Caused by fall on back of hand

Question 5

What are the features of a Bartons #? (3 things)

Answer 5

1. Intra-articular # (fracture within acc joint)
2. Radio-carpal joint dislocation (hallmark sign)
3. Volar (more common) or Dorsal displacement

Question 6

What are the clinical features of Distal Radius #s? (3 things)

Answer 6

1. Pain
2. Deformity + swelling
3. Paraesthesia / weakness = neurological involvement

Question 7

What should you check for @ examination of a sus Distal Radius #? (2 things)

Answer 7

Neurovasc compromise

1. Nerve function
2. Limb perfusion (cap refill + pulses)

Question 8

What nerves do you check in a neurological examination of a Distal Radius #? (3 things)

Answer 8

1. Median n
2. Ulnar n
3. Radial n

Question 9

How do you check for the motor + sensory function of the Median n. in a Distal Radius #?

Answer 9

Motor: thumb abduction (do C shape)
Sensory: inside of index finger tip

Question 10

How do you check for the motor + sensory function of the Ulnar n. in a Distal Radius #?

Answer 10

Motor: thumb adduction
Sensory: inside of pinky finger tip

Question 11

How do you check for the motor + sensory function of the Radial n. in a Distal Radius #?

Answer 11

Motor: extension of IPJ of thumb (straighten da thumb)
Sensory: dorsal surface of 1st webspace

Question 12

What investigation is done for a sus Distal Radius #?

Answer 12

Plain radiograph

Question 13

What measurements help w diagnosis of Distal Radius #? (3 things)

Answer 13

1. Radial height (11- mm)
2. Radial inclination (22- degrees)
3. Radial (volar) tilt (11+ degrees)

Question 14

What is the Radial height a measurement of?

What should it be?

Answer 14

If hand is stretched outwards (away from arm)

Less than 11mm

Question 15

What is the Radial inclination a measurement of?

What should it be?

Answer 15

If hand is inclined to one side (to / away from radius)

22 degrees (anyting between 21-25 degrees)

Question 16

What is the Radial (volar) tilt a measurement of?

What should it be?

Answer 16

If hand is titled up / down

11+ degrees

Question 17

What should a patient be evaluated for to see if they need surgery for a Distal Radius # or not? (6 things)

Answer 17

1. Age
2. Hand dominance
3. Occupation
4. Level of activity
5. Quality of bone
6. General medical condition

Question 18

What are the treatment options for Distal Radius #s? (2 things)

Answer 18

1. Non-operative (cast)
2. Operative

Question 19

What are the Operative options for Distal Radius #? (3 things)

Answer 19

1. Manipulation Under Anaesthesia (MUA) & K wires
2. Volar locking plating
3. External fixation

Question 20

What Distal Radius # is MUA & K wires best for?

Answer 20

2 part non-comminuted #s

(comminuted = broken into more than 2 fragments)

Question 21

What Distal Radius # is Volar locking plating best for? (2 things)

Answer 21

1. Comminuted, shortened osteoporotic #s
2. Smiths / volar Bartons #s

Question 22

What is External fixation used for in Distal Radius #s?

Answer 22

Less used now
Good for high energy multifragmentary #s

Question 23

What are the complications of Distal Radius #s? (6 things)

Answer 23

1. Malunion / Nonunion
2. Ulnar n Damage
3. Carpal Tunnel syndrome (median n)
4. OA
5. Compartment Syndrome
6. Infection