Distal Radius Fractures Flashcards
What is the most common cause of a distal radius fracture? risk factors?
fall on outstretched hand - distal radius takes 80% of axial load underneath the scaphoid and lunate fosse so FOOSH causes forced extension/flexion of the carpus increasing impaction load on the distal radium
Risk increases with age due to osteoporosis however children between 5-15 are also prone
What is the most common risk fracture? Describe
Colles’ - extra-articular transverse fracture of distal radius, 1 inch proximal to the radoiocarpal joint with dorsal angulation and dorsal displacement
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Avulsion fracture of the ulnar styloid (however not always present)
How does a Colles’ fracture occur?
Fragility fracture in osteoporotic bone with wrist dorsiflexed - fall onto extended outstretched hand
How is the Colles’ fracture described?
Dinner fork deformity due to dorsal angulation and dorsal displacement
What is a Smith’s fracture? how does it occur?
Reverse Colles’ fracture
Volar angulation of distal fragment of extraarticular fracture of distal radium ± volar displacement
Caused by landing on the solar surface of the wrist - falling backwards onto the palm of an outstretched hand or wrists flexed
Garden spade deformity
What is a Barton’s fracture?
Intraarticular fracture of the distal radius with associated dislocation of the radio-carpal joint
Volar (more common) or dorsal depending whether the solar or dorsal rim of the radius is involved
Fall onto extended and pronated wrist.
What are the risk factors for distal radius fractures?
Increasing age (or young) Female Early menopause Smoking/alcohol excess Prolonged steroid use (cause osteoporosis)
How do patients with distal radius fracture present?
Episode of trauma
Immediate pain ± deformity
Sudden swelling around the fracture site
Possible neuromuscular compromise
What nerves should be assessed in distal radius fracture?
Median nerve, motor - abduction of the thumb, sensory - radial surface of distal 2nd digit
Anterior interosseous nerve: opposition of thumb and index finger (OK sign - if the DIPJ of the 2nd and IPJ of thumb extend, signifies AIN involvement)
Ulnar nerve: motor - abduction of the thumb, sensory - ulnar surface of distal 5th digit
Radial nerve: motor - extension of IPJ of thumb, sensory - dorsal surface of 1st webspace
What are some differentials?
carpal bone fracture
tendonitis or tenosynovitis
wrist dislocation
What investigation would you order for a distal radius fracture?
plain radiograph AP an d lateral view Measurements: Radial heigh < 11cm Radial inclination < 22 degrees Radial volar tila > 11 degrees
What is the management of a distal radius fracture?
Closed reduction ensuring sufficient traction and manipulation under anaesthetic
Stable and succesfully reduced fractures can typically be placed in a below-elbow backstab case then radiographs repeated after 1 week to check for displacement.
Significantly displaced or unstable fractures can require surgical intervention as they have a risk fo otherwise displacing over time - options include open reduction and internal fixation, K-wire fixation or external fixation
Once sufficient bone healing has occurred, patients should be rehabilitated via physiotherapy to ensure full function.
What are the main complications of distal radius fracture
Malunion - poor realignment leads to a shortened radius compared to the ulnar leading to reduced wrist motion, wrist pain and reduced forearm rotation.
Median nerve compression
Osteoarthritis - especially with intra-articular involvement
How are malunion treated?
Corrective osteotomy
What is the clinical presentation of scaphoid fracture? How is it treated?
Swelling, Pain in the anatomical snuffbox as the scaphoid forms the floor with lateral border, abductor policis longs and medial border, extensor pollicis longus following fall on outstretched hand with hyper extension of the wrist.
Immobilisation with cast
Internal fixation for displaced fragments, usually with a headless self-compressing screw
