Wrist fractures; ankle fractures Flashcards
Label A-D
A: scaphoid
B: Lunate
C: triquetrum
D: Pisiform
Which bones are typically broken during a Colles’ fracture? [2]
What is meant by a Colles fracture [1]
Colles:
- Distal radius fracture
- There is an associated fracture of the ulna styloid in around 50% of cases.
Typically occurs due to FOOSH impaction with the forarm in dorsiflexion.
Explain the typical presentation of a Colles fracture [3]
Wrist pain and swelling
* Pain and swelling usually occur immediately after the fracture is sustained
* Movement at the wrist is painful
Wrist deformity
* Colles’ fractures typically cause a ‘dinner-fork’ deformity of the wrist, caused by dorsal displacement of the distal fragment of the radius.
Paresthesia and weakness
* If the fracture causes neurological damage this may result in paraesthesia and weakness of the wrist and/or fingers
* The median nerve is the most common nerve to be damaged by a Colles’ fracture, affecting up to 12% of cases caused by low-energy trauma and up to 30% of cases caused by high-energy trauma
What is the gold standard investigation for a Colles’ fracture? [1]
How does it appear ^? [1]
Plain radiograph using 2 views:
- AP (anteroposterior) and lateral view are sufficient for diagnosis although oblique views are sometimes included.
- Transverse fracture fracture is typically 2.5cm proximal to the radio-carpal (wrist) joint.
How do you manage a Colles’ fracture? [4]
Choice of management of a Colles’ fracture depends on the severity of the fracture. The most common treatment method is closed reduction with immobilisation with a plaster cast
open reduction and internal fixation (ORIF) used if:
* Unstable fracture
* Significant angulation of the distal fragment of the radius
* Usually defined as >10 degrees dorsal angulation
* Closed reduction is unsuccessful
* Comminuted fracture
Describe some complications of a Colles’ fracture [3]
Malunion
- Lead to dinner-fork deformity
Median nerve damage
- May lead to post-traumatic carpal tunnel syndrome
Rupture of EPL tendon
- Clinical features of an EPL tendon rupture include the inability to extend the interphalangeal joint of the thumb
Describe what is meant by a Galeazzi fracture [1]
How does a Galeazzi fracture typically occur? [1]
Galeazzi fracture
- This is a fracture of the radius which usually occurs at the junction of the middle and distal third of the radial shaft
- This injury is typically caused by a FOOSH with the elbow in flexion
Pain in the anatomical snuffbox would suggest which type of fracture? [1]
Carpal bone fracture:
- The most common carpal bone fracture is a fracture of the scaphoid bone
Describe what is meant by a Smith’s fracture? [1]
Fracture of the distal radius with volar angulation of the distal fragment
Often described as a reverse Colles’
Describe what is meant by a Barton fracture [1]
Barton fractures are fractures of the distal radius.
What type of fracture is depicted here? [1]
PA and lateral of a Colles’ fracture (note the dorsal angulation of the distal radial fragment)
Additionally, a fracture of the ulnar styloid is seen
What are the signs of a scaphoid fracture? [5]
Point of maximal tenderness over the anatomical snuffbox
This is a highly sensitive (around 90-95%), - - but poorly specific test (< 40%) in isolation
Wrist joint effusion
- Hyperacute injuries (< 4hrs old), and delayed presentations (>4days old) may not present with joint effusions.
Pain elicited by telescoping of the thumb (pain on longitudinal compression)
Tenderness of the scaphoid tubercle (on the volar aspect of the wrist)
Pain on ulnar deviation of the wrist
Describe the management for a scaphoid fracture
Initial management
* immobilisation with a Futuro splint or standard below-elbow backslab
* referral to orthopaedics: clinical review with further imaging should be arranged for7-10 days later when initial radiographs are inconclusive
Orthopaedic management:
* undisplaced fractures of the scaphoid waist: cast for 6-8 weeks
* displaced scaphoid waist fractures: requires surgical fixation
* proximal scaphoid pole fractures: require surgical fixation
Key complication of a scaphoid fracture? [1]
avascular necrosis
Ankle fractures involve which bones? [2]
Ankle fractures involve the lateral malleolus (distal fibula) or the medial malleolus (distal tibia).
Name and describe the classification system used for ankle fractures
Weber classification:
A
- Fracture below the level of the syndesmosis; typically from an inversion injury of the ankle.
B
- Fracture begins at the level of the syndesmosis and extends proximally in an oblique fashion.
- When accompanied by a fracture of the medial malleolus or rupture of the deltoid ligament, the ankle is considered unstable. Typically from an eversion injury of the ankle.
C
- Fractures above the syndesmosis, generally associated with syndesmotic injury.
- May be associated with an avulsion fracture of the medial malleolus or rupture of the deltoid ligament.
- Always unstable, requiring fixation.
Describe what is meant by the Ottawa ankle rules [1]
The Ottawa ankle rules help differentiate ankle injuries that require radiographic assessment from those that do not: only required if there is pain in the malleolar zone AND one or more of the following is found:
* Boney tenderness at the posterior edge or tip of the lateral malleolus OR
* Boney tenderness at the posterior edge or tip of the medial malleolus OR
* Inability to weight bear immediately and in the A+E department for four steps
What is meant by a pilon fracture? [1]
Pilon fractures: Involve the distal end of the tibia and may extend into the ankle joint.
Describe the management plan for a tibial plafond (pilon) fracture [3]
- Open reduction and internal fixation if affecting the articular surface or stability compromised
- Conservative if position maintained and joint stable and articular surface intact
- 6-8 weeks non-weight bearing and subsequent weight-bearing immobilisation up to further 6 weeks
