Distal radius fractures: Difference between revisions
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==Types== | ==Types== | ||
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==Differential Diagnosis== | ==Differential Diagnosis== | ||
Revision as of 22:05, 29 December 2014
Types
Distal radius fractures
- Colles' fracture
- Smith's fracture
- Barton's fracture
- Radial styloid fracture
- Distal radioulnar joint disruption
Distal radius fracture eponyms
| Eponyms | Description |
| Barton's | Fracture-dislocation of radiocarpal joint (with intra-articular fracture involving the volar or dorsal lip) |
| Chauffer's | Fracture of radial styloid |
| Colles' | Dorsally displaced, extra-articular fracture |
| Die-punch | Depressed fracture of the lunate fossa (articular surface) |
| Smith's | Volar displaced, extra-articular fracture |
Differential Diagnosis
Forearm Fracture Types
- Distal radius fractures
- Radia ulna fracture
- Isolated radius fracture (proximal)
- Isolated ulna fracture (i.e. nightstick)
- Monteggia fracture-dislocation
- Galeazzi fracture-dislocation
- Forearm fracture (peds)
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 is fx-dislocation or subluxation 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