Distal radius fractures

Question 1

Mechanism of injury

Answer 1

Commonly FOOSH
Direct trauma
Fall from height

Question 2

Types of distal radial fracture

Answer 2

Colle’s fracture - dorsal displacement

Smith’s fracture - volar displacement

Barton’s fracture - intra - articular

Question 3

How to test nerves

Answer 3

Median nerve:

• finger flexion
• sensation of index finger

Ulnar nerve:

• finger abduction
• sensation of little finger

Radial nerve:

• Wrist extension
• sensation of 1st web space on dorsal aspect of hand

Question 4

Which nerve commonly affected

Answer 4

Median nerve

Question 5

How to describe fracture

Answer 5

1. Intra or extra articular
2. Dorsal or volar displacement
3. Radial height and inclination
4. Comminuted

Question 6

Unstable fracture

Answer 6

1. Intra- articular
2. 11+ degrees of dorsal tilt
3. < 15 degrees of radial inclination
4. Loss of radial height by 5+ cm
5. Comminuted cortex
6. Irreducible
7. Loss of reduction after attempted reduction

Question 7

Ix

Answer 7

Xray

Question 8

Mx

Answer 8

1. NV status
2. Anaethesia - haematoma block
3. Traction + Reduction
4. Check XR
5. Cast - below elbow backslab
6. Recheck NV status
7. Elevate
8. Follow up after 1 week
9. Physio

Question 9

Complications of plaster

Answer 9

Compartment syndrome 
Failure or loss of reduction 
Skin complication - blistering 
Carpal tunnel with plaster due to palmar flexion 
NV injuries

Question 10

When to use plates

Answer 10

If comminuted

Question 11

How to treat unstable fractures

Answer 11

ORIF

Require surgery:

• K wires
• Plates

Open fracture - external fixation

Question 12

Colle’s fracture

Answer 12

FOOSH

Extra - articular

Dorsal displacement and angulation of distal
fragment

Dinner fork deformity

Shortened

Reduced inclination

+/- avulsion of ulna styloid

Question 13

How does a dorsal backslab work?

Answer 13

Provides 3-point

pressure

Question 14

Rehab

Answer 14

6 wks in POP (plaster of Paris) + physio

Question 15

Complications of radius fracture

Answer 15

• Median N. injury
• Carpal tunnel syn.
• Frozen shoulder / adhesive capsulitis
• Tendon rupture: esp. EPL
• Non - union

Question 16

Associated injuries with FOOSH

Answer 16

• Frozen shoulder / adhesive capsulitis

* Tendon rupture: esp. EPL

Question 17

Barton’s fracture

Answer 17

Oblique intra-articular

involving the dorsal aspect
of distal radius and dislocation of radio-carpal joint

Question 18

Froment’s sign

Answer 18

Flexion of thumb IPJ when trying to hold onto paper held between thumb and finger.

• Indicates weak adductor policis
• Ulnar nerve

Question 19

Risk factors for distal radius fractures

Answer 19

Increasing age
Female gender
Early menopause
Smoking or alcohol excess
Prolonged steroid use

Question 20

Presentation

Answer 20

Following trauma
Immediate pain +/- deformity
Sudden swelling

Question 21

Presentation

Answer 21

Following trauma
Immediate pain +/- deformity
Sudden swelling

Question 22

Xray results

Answer 22

Radial height <11mm
Radial inclination <22 degrees
Radial (volar) tilt >11 degrees

Question 23

Complications of distal radius fracture

Answer 23

• Median N. injury
• Carpal tunnel syn.
• Non - union
• OA