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
**Fracture line may extend into radioulnar or radiocarpal joint ("die-punch" fx)
**Fracture line may extend into radioulnar or radiocarpal joint ("die-punch" fx)
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*Ulnar styloid fx is often present and suggests injury to TFCC
*Ulnar styloid fx is often present and suggests injury to TFCC


===Clinical Features==
===Clinical Features===
*Characteristic dorsiflexion or "dinner-fork" deformity
*Characteristic dorsiflexion or "dinner-fork" deformity
*Palmar paresthesias (pressure on median nerve)
*Palmar paresthesias (pressure on median nerve)
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*Short arm splint; position wrist in mild flexion and ulnar deviation
*Short arm splint; position wrist in mild flexion and ulnar deviation


# Hutchinson's Fx
==Distal Radioulnar Joint Disruption==
## Radial styloid avulsion +/- lunate or scapholunate dissocation
===Background===
# Galeazzi Fx
*Seen w/ intra-articular or distal radial shaft fractures or both bone fracture
## Radial shaft Fx + dislocation of the distal radioulnar joint (ulna positive variance)
 
===Imaging===
==Treatment==
*PA
# Immediate reduction only required for neurovascular invovlement
**Narrowing and overlap of distal radioulnar joint
# Nondisplaced extra-articular fx
*Lateral
## Relatively stable
**Volar or dorsal displacement of ulna (which is usually centered/overlapping the radius)
## Sugar tong, reverse sugar tong, or double sugar tong splint
**Requires a true lateral to avoid a false positive result
### Elbow flexed to 90 degrees, arm in neutral position
 
# Displaced fx
===Management===
## Splint, arrange next-day f/u; reduction by experienced clinician is appropriate, but not required
*Dorsal dislocation
### Adequate reduction:
**Immobilize wrist in supination
#### No dorsal tilt of the distal radial articular surface
*Volar dislocation
#### Less than 5 mm of radial shortening
**Immobilize wrist in pronation
#### Less than 2 mm of displacement of fracture fragments
 
==Disposition==
# Refer all of the following:
## Palmarly displaced fx
## Articular step-off >2mm
## Large ulnar styloid fx with displaced fragments at the styloid base
## Fracture dislocations
## Distal radius fractures associated with scaphoid fractures or scapholunate ligament injuries
## Fractures with significant displacement or comminution
# Unstable fx
## Greater than 20 degrees of dorsal angulation
## Fracture displacement in any direction greater than two-thirds the width of the radial shaft
## Metaphyseal comminution with more than 5 mm of radial shortening
## Ulnar variance greater than 5 mm compared with the contralateral wrist (normal variance is 0 to -2 mm
## Intraarticular component (especially involving the DRUJ)
==Source==
==Source==
*UpToDate
*Tintinalli
*Tintinalli


[[Category:Ortho]]
[[Category:Ortho]]

Revision as of 04:09, 8 February 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

Source

  • Tintinalli
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