Distal radius fractures

Background

• Definition: Fracture at the metaphysis or the articulation of the distal radius
• One of the most common fractures seen in the ED (1/6th of all fractures treated)

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

Clinical Features

Distal radius fracture demonstrating the deformity in the wrist.

• Commonly from a fall on an outstretched wrist that is dorsiflexed
• Forearm trauma and pain
• Possible forearm deformity

Differential Diagnosis

Forearm Fracture Types

• Distal radius fractures
  • Colles' fracture
  • Smith fracture
  • Barton fracture
  • Radial styloid fracture
  • Distal radioulnar joint disruption
• Radia ulna fracture
• Isolated radius fracture (proximal)
• Isolated ulna fracture (i.e. nightstick)
• Monteggia fracture-dislocation
• Galeazzi fracture-dislocation
• Forearm fracture (peds)

Management

ED closed reduction

• Indications:
• Steps:
  1. Procedural sedation and/or hematoma block
  2. Axial traction
  3. Recreate, then reverse, mechanism of injury
     • Although recreating the injury briefly exaggerates the existing deformity, this maneuver "unlocks" any periosteal sleeve folded into the fracture site (which can be critical in achieving reduction)
     • Continue to maintain axial traction throughout manuver
     • For example with a fracture with dorsally angulated fragments, establish axial traction, then slightly bending the dorsal fragment even more dorsally while maintain traction, then reverse pressure to reduce the distal fragment volarly and back out to length, all while maintaining traction.
  4. Splint
  5. Re-image
• Goal:

Disposition

• Most can be treated with orthopedic follow up within 1 week

Admit

• Open fracture
• Neuro-vascular compromise
• Risk or concern for compartment syndrome
• Patient is unable to function at home (e.g. uses walker with that arm)

See Also

• Forearm fractures

External Links

• https://www.orthobullets.com/trauma/1027/distal-radius-fractures