Distal forearm fractures

Question 1

What is the typical presentation of a Colles’ fracture?

Answer 1

Fall on an outstretched hand
Dinner fork deformity
Commonly elderly females with osteoporosis

Question 2

What are some of the radiographic features of a Colles’ fracture?

Answer 2

Extra articular fracture of radius
Dorsal displacement + angulation of distal fragment
+/- Avulsion of ulnar styloid
+/- Impaction

Question 3

What is the management of a Colles’ fracture?

Answer 3

Assess NV status - Median nerve, radial artery
Reduction with backslab
Re X-ray - satsfactory - f/u + POP 6 weeks
Not satisfactory - Consider MUA + K wires

Question 4

What are some of the complications of a Colles’ fracture?

Answer 4

Misalignment
Median nerve damage
Adhesive capsulitis
Extensor pollicis longus tendon rupture
Carpel tunnel syndrome
CRPS

Question 5

What is a Smith’s fracture?

Answer 5

Reverse Colles’ (Distal fragment displaced anteriorly)
Fall onto back of flexed wrist
Reduce + POP for 6 weeks

Question 6

What are the clinical features of a Scaphoid fracture?

Answer 6

Fall on an outsretched hand

Pain in anatomical snuffbox

Question 7

What is the management of a Scaphoid fracture?

Answer 7

Scaphoid view x ray - may take 10 days to become apparent due to decalcification
Place wrist/hand in scaphoid plaster
After re xraying 10 days later;
Fracture visible - POP 6 weeks
No fracture visible, but tender - POP 2 weeks
No fracture visible, no tenderness - No action

Question 8

What are some of the complications of a Scaphoid fracture?

Answer 8

NV damage - blood supply runs distal to proximal so may develop AVN of scaphoid (Present as stiffness + pain at wrist)
Non union

Question 9

What is a Monteggia fracture?

Answer 9

Fracture of proximal 3rd of ulna shaft
Anterior dislocation of radial head at capitellum
May cause palsy of deep branch of radial nerve →
weak finger extension BUT no sensory loss

Question 10

What is a Galleazzi fracture?

Answer 10

Fracture of radial shaft between mid and distal 3rds

Dislocation of distal radioulnar joint

Question 11

What is the management of radial/ulnar shaft fractures?

Answer 11

Unstable fractures - adults = ORIF, children = MUA + POP
Proximal fracture - Supination plaster
Distal fracture - Pronation plaster
Mid shaft fracture - neutral plaster