Distal Radius Frac Flashcards
Types
Die punch- depressed frac of lunate fossa of articular surf.
Bartons- frac disloc radiocarpal jnt, intra artic.
Chauffers- radial styloid.
Colles- low energy dorsally displ transv extra artic. Comm in eld wom, link to OP, FOOSH. Frac corticocancellous junc. Distal frag collapses into- ext, dorsal displ, radial and dorsal tilt, shorten. Ulnar styloid may also be broken. Can be intra artic or comminuted.
Smiths- low energy volar displ transv extra artic. Fall on back hand. Frac metaph. Volar tilt.
Wrist jnt inj eg lig dam can cause instabil of distal radio ulnar or radio carpal jnt.
Mx
-non op-
Closed reduc and cast immob if extra artic and min displ
-op-
Fixation (CRPP percutan pin, ext, oRIF) if unstable eg displ, intra artic, comminuted, artic margins, sev OP.
-cast for 6wk, XR after 1 wk to check reduc. Acceptable is under 5mm or 5 deg
-physio
Complics
Early circ probs CTS Ulnar N neuropathy Reflex sympathetic dystrophy EPL rupture Radiocarpal arhtrosis Mal/non union Stiffness, musc weakness ECU or EDM entrap Compartment synd CRPS
Colles tx
Undispl- dorsal splint for 1-2d, then cast. XR for 10-14d. Remove at 4wk.
Displ- open or closed reduc, int fixat if req.
impacted or comminuted- ext fixat for 5-6 wk us req. or volar locking plate. Or IMNs or crossed K wires.
Smiths tx
Reduc
Immob 6wk
Unstable may req percutan wires or plate
OP RF
Ca removed from bone, not repl causes corticocancellous junc weakest area.
OP also risk NoF and spine frac.
Normal measurements
Volar tilt 11 deg
Radial length 11mm from artic surf to styloid tip
Radial inclination 22 deg
If shorten 3-6mm
Ulnar pain and impactation, reduced rot, reduc grip as loss dorsiflex and ulnar dev. Tenodesis effect.
? Intra or extra articular
Radio carpal or radioulnar inv
Median N test
Ok sign- FPL, FDP index
Also abduc pollicis
if NV inj
Urgent reduc-
Correct length by pull
Correct dorsal tilt by palmar flexion
Correct radial dev by ulnar dev
