EM Ortho 11: Distal Radius and Ulna

Question 1

most common pediatric fracture

Answer 1

distal radius fracture
(<16 years)

Question 2

Remarks on Colles’ fracture

Answer 2

distal radial metaphysis fracture that’s dorsally angulated and displaced proximally and dorsally

dorsiflexed wrist = “dinner fork” deformity

patients may complain of palmar paresthesias from pressure on the median nerve

Question 3

what are unstable Colles’ fracture

Answer 3

> 20 degrees of angulation,
intra-articular involvement,
marked comminution, or
1 cm of shortening

Question 4

management of Colles’ fracture

Answer 4

stable: compression dressing and splint until they can be evaluated by an orthopedic surgeon within 7 to 10 days

unstable: closed reduction and application of sugar-tong splint for 4-6 weeks

Question 5

most common complication of Colles’ fracture

Answer 5

immediate or delayed carpal tunnel syndrome

Question 6

Remarks on Smith’s fracture

Answer 6

volar angulated fracture of the distal radius

hand is displaced palmarly and produces a “garden spade” deformity

treatment objectives and complications are much like those seen with the Colles’ fracture

Question 7

remarks on Barton’s fractures

Answer 7

dorsal (more common) or volar rim fractures of the distal radius

Question 8

management of Barton’s fracture

Answer 8

minimally displaced fractures:
treated acutely in a sugar-tong splint until evaluation by an orthopedist

unstable fx involving >50% of the radial articular surface or those with carpal subluxation:
ORIF

Question 9

remarks on radial styloid fracture

Answer 9

often accompanied by a lunate dislocation

displaced fx may produce carpal instability —> often require ORIF

displacement of as little as 3 mm is often associated with accompanying scapholunate dissociation

Question 10

mgt of radial styloid fracture

Answer 10

in the ED, place a short arm splint positioning the wrist in mild flexion and ulnar deviation

Question 11

remarks on ulnar styloid fracture

Answer 11

a forced radial deviation, dorsiflexion, or rotatory stress can fracture the ulnar styloid

patients complain of a painful clicking or locking sensation in the wrist

Question 12

mgt of ulnar styloid fracture

Answer 12

if DRUJ is stable:
treated acutely in an ulnar gutter splint in slight ulnar deviation and neutral positioning of the wrist

if there’s any quiestion about stability:
referred acutely for surgical evaluation
*arthrograms or MRI imaging may be necessary to delineate the full extent of injury

Question 13

Galeazzi’s injury

Answer 13

distal radial shaft fracture with disruption of triangular fibrocartilage complex of the DRUJ

Question 14

signs of DRUJ instability

Answer 14

ulnar styloid fracture involving the base with ≥2 mm displacement,
radius sigmoid notch fracture
wide DRUJ displacement
shortened radius
failure to reduce DRUJ dislocation

Question 15

a true lateral view in DRUJ dislocation `

Answer 15

there is superimposition of the four ulnar metacarpals,
superimposition of the proximal pole of the scaphoid with the lunate and triquetrum,
and the radial styloid centered over its distal articular surface

Question 16

management of DRUJ dislocation

Answer 16

immobilizing the wrist in supination reduces dorsa dislocation

whereas volar dislocation are placed in pronation

referred acutely for ortho ff up
*may have high recurrence rate and may require reconstructive surgery, particularly if there’s delay in diagnosis