Distal radius fractures

Diagnosis

• Mechanism often c/w FOOSH
• Examine for deformity
  • "Dinner-fork" deformity common with Colles' fracturs
• Examine for impaired sensation of thumb, IF
  • Median nerve injury is common in displaced fractures

Imaging

1. Is there loss of normal anatomy (e.g. fx displacement or angulation, loss of radial height)
2. Is there involvement of the radiocarpal or distal radioulnar joint?
3. Is there discontinuity of the articular surface or diastasis (separation) of the articular fragments?
4. Are high-risk features present (severe comminution, articular step-off >2 mm, fracture-dislocation)?

1. PA
   1. Radial inclination (angle between line perpendicular to long axis of radius and line between radial styloid and ulnar corner of lunate fossa)
      1. Normal = 15-25 degrees
         1. Often smaller with fx
   2. Radial height (Distance between distal tip of radial styloid and articular surface of the radius)
      1. Normal ~ 10-17mm
         1. Often smaller with comminuted or impacted fx
   3. Ulnar variance (Distance between ulnar-side articular surface of radius and the ulnar carpal surface)
      1. Normally 1-2mm
2. Lateral
   1. Palmar Tilt (angle between line perpendicular to long axis of radial shaft and line through the apices of the palmar and dorsal rims of the radius
      1. Normally 10o-25o
         1. Often smaller with fx
3. Oblique
   1. May reveal intra-articular involvement not seen on other views

Fracture Types

1. Colles' Fx
   1. Dorsal displacement of the distal radius fragment
2. Smith's Fx
   1. Palmar displacement of distal radius fragment
3. Hutchinson's Fx
   1. Radial styloid avulsion +/- lunate or scapholunate dissocation
4. Galeazzi Fx
   1. Radial shaft Fx + dislocation of the distal radioulnar joint (ulna positive variance)
5. Barton's Fx-dislocation
   1. Palmar Barton's
      1. Radial avulsion + palmar displacement of radiocarpal unit
   2. Dorsal Barton's
      1. Radial avulsion + dorsal displacement of radiocarpal unit

Treatment

1. Immediate reduction only required for neurovascular invovlement
2. Nondisplaced extra-articular fx
   1. Relatively stable
   2. Sugar tong, reverse sugar tong, or double sugar tong splint
      1. Elbow flexed to 90o, arm in neutral position
3. Displaced fx
   1. Splint, arrange next-day f/u; reduction by experienced clinician is appropriate, but not required
      1. Adequate reduction:
         1. No dorsal tilt of the distal radial articular surface
         2. Less than 5 mm of radial shortening
         3. Less than 2 mm of displacement of fracture fragments

Disposition

1. Refer all of the following:
   1. Palmarly displaced fx
   2. Articular step-off >2mm
   3. Large ulnar styloid fx with displaced fragments at the styloid base
   4. Fracture dislocations
   5. Distal radius fractures associated with scaphoid fractures or scapholunate ligament injuries
   6. Fractures with significant displacement or comminution
2. Unstable fx
   1. Greater than 20 degrees of dorsal angulation
   2. Fracture displacement in any direction greater than two-thirds the width of the radial shaft
   3. Metaphyseal comminution with more than 5 mm of radial shortening
   4. Ulnar variance greater than 5 mm compared with the contralateral wrist (normal variance is 0 to -2 mm
   5. Intraarticular component (especially involving the DRUJ)

Source

UpToDate