Distal radius fractures

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)

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

Colles fracture

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

• Forearm fractures

Source

• Tintinalli