T&O: Distal Radius Fracture Flashcards
Outline the pathophysiology of a distal radius fracture.
Distal radius takes 80% axial load underneath the scaphoid and lunate fossae = FOOSH causes forced extension or flexion of the carpus = increases the impaction load of the distal radius
COLLES = 90%, extra-articular # DR with dorsal angulation and dorsal displacement, within 2cm of the articular surface + avulsion fracture of the ulnar styloid
SMITHS = extra-articular # DR with volar angulation +/- volar displacement
BARTONS = intra-articular # DR, with dislocation of the radio-carpal joint, volar (more common) or dorsal (less common)
Outline the aetiology of a distal radius fracture.
Colles = FOOSH
Smiths = landing on the dorsal surface of the wrist
What are the symptoms of a distal radial fracture?
Acute pain
+/- deformity
Swelling
Paraesthesia
Weakness
What are the risk factors leading for osteoporosis?
Increasing age
Female
Early menopause
Smoking or alcohol excess
Prolonged steroid use
How would you investigate a distal radius fracture?
Cap refill
Nerve function = sensation, motor (medium, ulnar, radius, anterior interosseous)
X-ray
CT or MRI - in more complex distal radius fractures, particularly for operative planning
How would you manage a distal radius fracture?
Resuscitation
Stabilisation
Closed reduction
Back slab
Surgery = ORIF, K-wires, external fixtion
Physiotherapy
What are the complications of a 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 from the original fracture
What are the structural parameters of a normal wrist?
Radial height <11mm
Radial inclination <22 degrees
Radial (volar) tilt >11 degrees
