distal radius fracture

Question 1

where at the distal radius do the fractures occur?

Answer 1

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

Question 2

what is the most common type of wrist fracture?

Answer 2

Colles fracture

Question 3

what commonly causes distal radial fractures?

Answer 3

fall on an outstretched hand

this causes forced supination or pronation of the carpus, increasing impaction loan of the distal radius

due to osteoporosis, risk of fracture increases with age

Question 4

what is a Colles fracture?

Answer 4

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

typically occurs as a fragility fracture in osteoporotic bone

occurs as a result of fall onto outstretched hand, which is forced into supination

Question 5

how is a colles fracture commonly described?

Answer 5

dinner fork deformity

Question 6

what is a Smith’s fracture?

Answer 6

volar angulation of the distal fragment of an extra articular fracture of the distal radius, with or without volar displacement

(the reverse of a colles fracture)

usually caused by falling backwards and planting the outstretched hand behind the body, causing a forced pronation type injury

Question 7

what is a Barton’s fracture?

Answer 7

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

Question 8

what are the risk factors for distal radius fractures?

Answer 8

main risk factors are related to osteoporosis

• increasing age
• female
• early menopause
• smoking/alcohol excess
• prolonged steroid use

Question 9

what are the clinical features of distal radial fractures?

Answer 9

• present following episode of trauma
• immediate pain
• may have deformity
• sudden swelling around fracture site
• neurological involvement can result in paraesthesia or weakness

Question 10

what nerves should be assessed in neurological examination for a suspected distal radius fracture fracture?

Answer 10

• median nerve. motor = thumb abduction and sensory = radial surface of distal 2nd digit.
• ulnar nerve. motor = adduction of thumb. sensory = ulnar surface of distal 5th digit.
• radial nerve. Motor = extension of IPJ of thumb. Sensory = dorsal surgace of 1st webspace.

Question 11

what are your differentials?

Answer 11

• forearm fracture
• carpal bone fractures
• tendonitis or tenosynovitis
• wrist dislocation

Question 12

what investigations are done?

Answer 12

• plain radiograph

three measures can be used for diagnosis

• radial height <11 mm
• radial inclination <22 degrees
• radial (volar) tilt >11 degrees
• CT or MRI can be used in more complex fractures, particularly in operative planning, but this can be done once initial management steps have occurred

Question 13

how is a distal radial fracture managed generally?

Answer 13

• resuscitate and stabilise patient
• closed reduction of displaced fracture using anaesthetic
• below elbow backslab cast, then radiograph repeated after 1 week to check for displacement
• once sufficient bone healing has occurred, rehabilitate with physiotherapy to ensure regaining of full function

Question 14

when would a distal radial fracture be managed surgically?

Answer 14

in significant displacement as may displace further over time if not stabilised, or a fracture with an intra articular step of the radiocarpal joint

options include Open reduction and internal fixation (ORIF) or K wire fixation

external fixation is rarely used

then cast for immobility

Question 15

what are the complications of a distal radial fracture?

Answer 15

• malunion
• median nerve compression
• osteoarthritis