Distal radius fractures: Difference between revisions
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==Colles Fracture== | ==[[Colles Fracture]]== | ||
===Background=== | ===Background=== | ||
*Distal radial metaphysis fx that is dorsally displaced and angulated | *Distal radial metaphysis fx that is dorsally displaced and angulated | ||
| Line 28: | Line 28: | ||
**Immediate ortho referral | **Immediate ortho referral | ||
==Smith Fracture== | ==[[Smith Fracture]]== | ||
===Background=== | ===Background=== | ||
*Volar angulated fx ("reverse Colles fracture" or "garden-spade deformity") | *Volar angulated fx ("reverse Colles fracture" or "garden-spade deformity") | ||
| Line 39: | Line 39: | ||
*Similar to Colles fracture | *Similar to Colles fracture | ||
==Barton Fracture== | ==[[Barton Fracture]]== | ||
===Background=== | ===Background=== | ||
*Dorsal or volar rim fx | *Dorsal or volar rim fx | ||
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**Accompanying carpal subluxation | **Accompanying carpal subluxation | ||
==Radial Styloid Fracture== | ==[[Radial Styloid Fracture]]== | ||
===Background=== | ===Background=== | ||
*Often accompanied by lunate dislocation | *Often accompanied by lunate dislocation | ||
Revision as of 23:41, 7 March 2012
Colles Fracture
Background
- Distal radial metaphysis fx that is dorsally displaced and angulated
- Fracture line may extend into radioulnar or radiocarpal joint ("die-punch" fx)
- Occurs due to FOOSH
- Ulnar styloid fx is often present and suggests injury to TFCC
Clinical Features
- Characteristic dorsiflexion or "dinner-fork" deformity
- Palmar paresthesias (pressure on median nerve)
Imaging
- PA
- Distal metaphyseal fx that often appears shortened from angulation or comminution
- Lateral
- Provides best view of dorsal angulation and comminution
Management
- Assess for instability:
- >20 degrees angulation
- Intra-articular involvement
- Marked comminution
- >1cm shortening
- Stable Fracture
- Compression dressing and sugar tong splint
- Closed reduction may be attempted
- Unstable Fracture
- Immediate ortho referral
Smith Fracture
Background
- Volar angulated fx ("reverse Colles fracture" or "garden-spade deformity")
- Occurs due to fall or direct blow to dorsum of hand/wrist
Imaging
- Similar but opposite to Colles fracture
Management
- Similar to Colles fracture
Barton Fracture
Background
- Dorsal or volar rim fx
- Often fx-dislocations or subluxations because carpus is displaced in direction of the fx
Imaging
- PA
- Communiuted fx of distal radial metaphysis
- Lateral
- Intra-articular fx of volar or dorsal rim of radius
Management
- Minimally displaced: sugar tong splint and ortho referral
- Unstable requires ORIF
- >50% of radial articular surface
- Accompanying carpal subluxation
Radial Styloid Fracture
Background
- Often accompanied by lunate dislocation
- Often assoc w/ carpal instability (carpal ligaments insert on the radial styloid)
Management
- Short arm splint; position wrist in mild flexion and ulnar deviation
Distal Radioulnar Joint Disruption
Background
- Seen w/ intra-articular or distal radial shaft fractures or both bone fracture
Imaging
- PA
- Narrowing and overlap of distal radioulnar joint
- Lateral
- Volar or dorsal displacement of ulna (which is usually centered/overlapping the radius)
- Requires a true lateral to avoid a false positive result
Management
- Dorsal dislocation
- Immobilize wrist in supination
- Volar dislocation
- Immobilize wrist in pronation
See Also
Source
- Tintinalli