Distal Radius Fractures

Question 1

Three most common distal radius fractures

Answer 1

Colle’s (accounts for 90%)

Smith’s

Barton’s

Question 2

Mechanism of injury

Answer 2

Most commonly by FOOSH

Distal radius takes 80% of axial load underneath the scaphoid and lunate fossae.

A FOOSH -> forced supination or pronation of carpus -> Increased impaction load of distal radius

Question 3

Risk factors

Answer 3

Bimodal

Osteoporosis (fragility fractures)

Female gender

Early menopause

Smoking and alcohol excess

Prolonged steroid use

However children between 5-15 ys are also prone to these fractures

Question 4

Explain Colle’s fracture

Answer 4

Extra-articular

Dorsal angulation + dorsal displacement within 2cm of the articular surface

Transfer of load as their body falls forces wrist into supination

Question 5

What more than the radius does a Colle’s fracture include?

Answer 5

Avulsion fracture of the ulnar styloid (but might not always be present in fracture termed as Colle’s)

Question 6

Explain Smith’s fracture

Answer 6

Extra-articular of distal radius

Volar angulation

Reverse Colle’s fracture

Happens on FOOSH when falling backwards and plant the hand behind the body causing forced pronation type injury

Question 7

Explain Barton’s fracture

Answer 7

Intra-articular fracture of distal radius with dislocation of radio-carpal joint

Can be described as both volar (more common) and dorsal.

Question 8

Clinical features

Answer 8

Following episode of trauma

Immediate pain +/- deformity

Sudden swelling around fracture site

Neurological involvement can be present -> Paraesthesia and weakness

Question 9

Examination findings

Answer 9

Tenderness

Check for neurovascular damage (nerves + limb perfusion, capillary refill and pulse)

Also examine joint above and below

Question 10

Explain Neurological examination

Answer 10

Assess median nerve -> Abduction of thumb + radial surface of distal 2nd digit
Anterior interosseus -> opposition of thumb and index finder

Ulnar nerve -> Adduction of thumb (Froment’s sign) + ulnar surface of distal 5th digit

Radial nerve -> Extension of IPJ of thumb + dorsal surface of 1st webspace

Question 11

Dx

Answer 11

Forearm fracture like Galeazzi or Monteggia

Carpal bone fracture

Tendonitis or tenosynovitis

Wrist dislocation

Question 12

Ix

Answer 12

Plain radiographs

Further CT or MRI imaging might be done in complex cases and for operative planning.

Question 13

What should be done on X-ray in order to aid diagnosis?

Answer 13

Three measuresments:

Radial height < 11m

Radial inclination < 22 degrees

Radial (volar) tilt > 11 degrees

Question 14

General management

Answer 14

Resuscitate and stabilise patient first

Question 15

What will all displaced distal radius fractures need?

Answer 15

Closed reduction in emergency department

Question 16

There are various techniques that can be done, but what do all need?

Answer 16

Traction and manipulation under anaesthetic.

It can be conscious sedation by haematoma block or Bier’s block

Question 17

Following reduction, what is the post-operative management?

Answer 17

Restrict arm for bone healing.

Below-elbow backslab cast -> Radiographs repeated after 1 week to check for displacement

Once sufficient bone healing has been done -> Physio

Question 18

Indications for surgical management

Answer 18

Significant Displacement

Unstable fractures

Intra-articular step of the radiocarpal joint > 2mm

Question 19

Surgical management

Answer 19

ORIF with plating or K-wire fixation

External fixation is rarely used.

Question 20

Main complications of distal radius fractures

Answer 20

Malunion -> reduced wrist motion, wrist pain and reduced forearm rotation -> treated with corrective osteotomy.

Median nerve compression

OA