Distal Radius Fractures

Question 1

What percentage of distal radius fractures are intra-articular?

Answer 1

50%; radial styloid fractures indicate higher energy mechanism

Question 2

What are the radiographic norms and acceptable displacements in distal radius fractures?

Answer 2

Normal:
radial height- 11mm
radial inclination- 23°
volar tilt- 11°

Acceptable displacement:
radial height- with 2-3mm of contralateral wrist
radial inclination- Change of

Question 3

What are LaFontaine’s criteria for distal radius fractures?

Answer 3

1) Dorsal angulation >20
2) Dorsal comminution >50%, Palmar comminution, Intra-articular comminution
3) Initial displacement >1cm
4) Initial radial shortening >5mm
5) Associated ulnar fracture
6) Severe osteoporosis

Patients with 3 or more factors have high chance of loss of reduction. Among these variables radial shortening is the most predictive of instability followed by dorsal comminution.

Question 4

In treating distal radius fractures spanning external fixation does not correct what deformity?

Answer 4

volar tilt

Question 5

In volar locked plating of a distal radius fracture what is the most common tendon rupture?

Answer 5

FPL; up to 12%

Question 6

When should a carpal tunnel release be performed in a distal radius fracture?

Answer 6

1) Complete median n. injury
2) Progressive median n. parasthesias
3) Parasthesias do not improve or worsen with reduction

Question 7

What tendon rupture is associated with non-displaced distal radius fractures?

Answer 7

EPL; 3-5% of non-displaced fxs treated non-operatively
0.3% in those treated with ORIF
Treat with an EIP to EPL transfer

Question 8

What deformity is associated with greatest loss of wrist function and degenerative changes in extra-articular distal radius fxs?

Answer 8

Loss of radial height

Question 9

The Shuck test is performed after fixation of the distal radius to assess the status of the DRUJ, which ligaments are tested?

Answer 9

The radioulnar; Excessive sagittal plane ulnar translation signifies DRUJ injury.

Question 10

In a comminuted distal radius fracture, which fragment may need fragment specific fixation?

Answer 10

Small distal volar lunate-facet fragment; distal volar lunate fragment is the site of origin of the strong volar radiolunate ligaments which insert onto the lunate, and so displacement of this small piece volarly will allow the lunate and the rest of the carpus to subluxate volarly

Question 11

What are the reduction maneuvers for distal radius fractures during ORIF?

Answer 11

Traction- restores length
Palmar translation- restores volar tilt
Slight pronation and ulnar deviation- corrects common supination deformity

Question 12

Whats the regimen when casting distal radius fractures?

Answer 12

1) Can place in short arm or long arm cast in supination or neutral
2) Follow weekly with xrays for three weeks; always compare to first reduction film
3) Cast for 6-8 weeks total

Question 13

What is the interval for the volar Henry approach to the distal radius?

Answer 13

Floor of the FCR sheath;
btw the FCR and radial a.; FPL is retracted ulnarly then the pronator quadratus is excised and retracted ulnarly as well; brachioradialis can be sharply dissected from radial styloid;

Question 14

What are indications for the use of a dorsal spanning bridge plate in distal radius fractures?

Answer 14

1) high-energy injuries
2) fracture extension into the radius and ulnar diaphysis,
3) multiple extremity injuries who require load bearing for mobilization.

Question 15

What is a contraindication to volar locked plating of distal radius fracture?

Answer 15

dorsal shear fractures or as sole fixation in complex dorsally displaced fractures;
Use dorsal buttress plating instead