Fracture of the distal radius.

Question 1

What are the risk factor for distal radius fracture

Answer 1

high incidence in women >50 years old and it is a predictor for more fractures

DEXA (bond density scan( recommended for these type of women

FOOSH - fallen into an outstretched arm

THEY ARE ALSO THE MOST COMMON ORTHOPEDIC INJURY

Question 2

what is distal radius fracture associated with ?

Answer 2

DRUJ injuries - must be evaluated

soft tissue injury :
TFCC (triangle fibrocartilage injury ) injury
scapholunate lig injury
lunotriqueteral lig injury

Question 3

classification of distal radial head fracture ?

Answer 3

interarticular fractures :

die punch fracture - depressed fracture at the lunate fossa of the radius

barton fracture -
there is volar barton fracture (motor common)

dorsal barton fracture

fracture dislocation of the radoiocarpal joint with interarticular fracture

the intrartiucular involvement distinguishes it from colles or smooth

chauffer fracture - radial styloid fracture

indicates higher energy trauma

====================
EXTRARTICULAR FRACTURES
==================

colles fracture -
extraarticular fracture

distal radius is dorsally displaced in relation to the volar displaced radial shaft
(3)

need lateral view

most common - also known as dinner fork deformity

smiths fracture -
extrarticular fracture

volar displaced radial head in relation to the dorsally replaced radial shaft

type 1 - extraraticular trasnverse fracture

type 2 - fracture crosses into dorsal articular surface

type 3 - fracture enters the radiocarpal joint and dorsal articular surface - dorsal barton fracture is a smith fracture type 3

NEED lateral view

low energy

Question 4

what the cause of colles fracture ?

Answer 4

occurs in patients more that 50 years old and attempting to break a fall with an outstretched hand

Question 5

what causes barton fracture ?

Answer 5

fall on extended and pronated wrist

Question 6

what causes smiths fracture ?

Answer 6

a direct blow to the dorsal forearm or falling on flexed wrist as opposed to colles fracture

Question 7

what is the cause of chauffeur fracture ?

Answer 7

falling onto outreached hand

scaphoid pushing into the radial styloid

Question 8

what is the criteria for non operative radial head fracture ?

Answer 8

extra articular

in AP view
radial height change less than 5 mm shortening

radial inclination change less than 5 degrees

articular step off is less than 2 mm
(that gap between the radius and the carpal bone scaphoid)

===
in lateral view

dorsal angulation less than 5 degrees

Question 9

what are the indications for operative measures ?

Answer 9

closed reduction and percutaneous pinning

for extra articular and stable volar cortex

=====
ORIF - for anything not meeting the non operative criteria

====

external fixations usually combined with percutenaous pinning because this on its own cannot restoration the 10 degrees palmar tilt

open fractures
very highly comminuted

Question 10

what is the technique for closed reduction and splint / cast immobilisation ?

Answer 10

apply first longitudinal traction and volar or dorsal pressure to the distal fracture fragment

no difference in closed treatment and open treatment for elderly patients

if you have to repeat the closed reduction you will get less than 50 percent satisfactory results

Question 11

what is the treatment of chauffeur fracture ?

Answer 11

if minimally displaced closed reduction and cast immobilisation

displaced
closed reduction herbert screw fixation
k wire fixation

Question 12

what is the treatment for barton fracture ?

Answer 12

open reduction and internal fixation of volar T buttress plate preferred over dorsal plating

Question 13

what is the treatment for smiths fracture ?

Answer 13

non displaced cast immobilisation - wrist splinted in extension

mild displacement and angulation - closed reduction and percutaneous pinning

operative measures met
open reduction and internal volar locking plate fixation of the radius (volar plating is proffered)

use dorsal plating if dorsal intraarticular fracture and dorsal comminution

Question 14

how do we treat colles fracture ?

Answer 14

if undisplaced - in palmar flexion and ulnar deviation

if mild angulation and displacement which has not met the operative margins we can do closed reduction and percutaneous pinning

open reduction and volar locking plate fixation if operative criteria met

Question 15

why is volar plating preffered ?

Answer 15

dorsal plating causes irritation of the extensor tendon

Question 16

what is a major complication of volar plating ?

Answer 16

rupture of pollicus longus

Question 17

clinical presentation of colles fracture

Answer 17

dinner fork deformity

Question 18

clinical representation of smith fracture ?

Answer 18

garden spade deformity

Question 19

what does the distal radius articulate with ?

Answer 19

distal radius articular with scaphoid via scaphoid fossa

lunate via lunate fossa

distal ulna : via ulnar sigmoid notch

Question 20

what are the complications of distal radiation fractures

Answer 20

esp with closed reduction - acute carpi tunnel syndrome with casting
and EPL rupture - nondisplaced distal radial fractures have a higher rate of spontaneous rupture of the EPL tendon

======

for open reduction and internal fixation with volar plating - rupture of FPL - very distal volar plate placement on the radius

=====

MEDIAN NERVE NEUROPATHY - most FREQUENT neurological complication - treatment is acute carpi tunnel release
- there is progressive parenthesis , weakness in thumb opposition
for parenthesis that do not respond to reduction and last more than 24 hors
= PREVENTED BY AVODING IMMOBILISATION IN EXCESSIVE WRIST FLEXION OR ULNAR DEVIATION

=====

ulnar nerve neuropathy
risk : DRUJ

=====