Distal radius fractures
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Distal Radius Fractures. Distal Radius Anatomy. Radial Styloid Lister’s Tubercle Ulnar styloid DRUJ. Radiographic Anatomy. Radial Inclination – 22 degrees Radial Ht – 11 mm Volar Tilt – 11 degrees Ulnar Varience. RADIAL Height (x) = ~ 11 – 12 MM; INCLINATION = ~ 22 0.

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Distal Radius Fractures

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Distal radius fractures

Distal Radius Fractures


Distal radius anatomy

Distal Radius Anatomy

  • Radial Styloid

  • Lister’s Tubercle

  • Ulnar styloid

  • DRUJ


Radiographic anatomy

Radiographic Anatomy

  • Radial Inclination – 22 degrees

  • Radial Ht – 11 mm

  • Volar Tilt – 11 degrees

  • Ulnar Varience


Distal radius fractures

RADIAL Height (x) = ~ 11 – 12 MM;

INCLINATION = ~ 220

VOLAR TILT = ~ 110


What is ulnar variance

What is Ulnar Variance?

Ulnar Negative

Ulnar Positive


Radiographic anatomy1

Radiographic Anatomy

  • MRN 34611947

  • Draw lines using PACS


Fracture subtypes of the distal radius

Fracture Subtypes of the Distal Radius

  • Colles

  • Smiths

  • Bartons – Volar and Dorsal

  • Chauffeur's Fracture


Colles fracture

Colles Fracture

  • Classically - low energy extra articularfrx of distal radiusoccuring in elderly individuals

  • dorsally displaced and angulated, apex volar

  • Mechanism - FOOSH

    • In extended position

  • dorsal surface undergoes compression while volar surface undergoes tension

    • Dorsal surface – communition!


Colles fracture clinical appearance

Colles Fracture - Clinical Appearance

Dinner Fork Deformity


Distal radius fractures

Describe this fracture

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Smith s fracture reverse colles

Smith’s Fracture (Reverse Colles)

  • Classically - extraarticular palmarly displaced, volar angulation (apex dorsal) distal radius frx

  • "Garden Spade" deformity

  • Mechanism – fall on flexed wrist


Distal radius fractures

Describe this fracture

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Barton s fracture

Barton’s Fracture

  • distal radius fracture w/ dislocation of radiocarpal joint

    • dislocation is the most striking radiographic finding

    • # involves – volar or doral rim/lip of distal radius

    • often occurs along with a radial styloid #


Distal radius fractures

Describe this fracture


Chauffeur s fracture

Chauffeur’s Fracture

  • radial styloid #

  • Mechanism - tension forces sustained during ulnar deviation and supination of the wrist

    • Radiocarpal ligaments avulse  radial styloid from metaphysis of the radius;    - ligamentous attachments maintains alignment radial styloid to carpus, 

    • Styloid displaced from the rest of radius by pull of brachioradialis


Describe this fracture

Describe this fracture


Intra articular fractures

Intra-articular Fractures

  • Any of these fractures can be intra articular

  • Look for intra-articular steps

  • There are typical intra-articular fragments

  • Frykman Classification


Distal radius fractures

Describe

0589031-4


Does this fracture need to be reduced

Does this fracture need to be reduced?

  • Is fracture in acceptable position?

    • Radial Ht – 11 mm

    • Radial incline – 22 degrees

    • Volar Tilt – 11 degrees

    • IA Step < 1-2 mm

    • Ulnar variance – equal to other wrist

  • Is my reduction acceptable?

    • Use above criteria

  • Not acceptable?

    • Consider patient, consider OR


How to do a reduction

How to do a reduction

  • Pain control

    • Ativan (relax the nervous), pain med (background pain control – morphine, tylenol)

    • Conscious sedation – IV fentanyl, midazolam

    • Hematoma block

    • “ouch block”

  • Tips

    • 1st CMC arthritis – change your grip

    • Watch out for thin skin


How to do a hematoma block

How to do a Hematoma Block

  • Essentially - Just freeze the fracture site!!

  • Demonstration


Reduction

Reduction

  • Look at x-ray – come up with a reduction plan for every fracture!

  • Set-up

    • Finger Traps?

    • Assistants?

    • Solo?

  • How to do a reduction

    • Colles – cast in neutral and flexion

    • Smiths – cast in supination and extension

  • Demonstration – different methods, colles/smiths


Casting

Casting

  • Tips

    • Stockingette?

    • Soft roll application

    • Plaster

    • Water temp

  • 3 point moulding

    • At fracture, NOT WRIST

  • Other moulding tips

    • Ulnar deviation


Casting complications

Casting Complications

  • Acute Carpal Tunnel

    • Don’t hyperflex wrist – basically putting them in prolonged Phalen position


Casting complications1

Casting Complications

  • Compartment Syndrome

    • Avoid the tight cast!

    • If swelling a concern- bivalve your cast


Late complications

Late Complications

  • EPL Rupture

  • RDS

  • Malunion

  • Nonunion

  • Radiocarpal Arthrosis


What do we do in the or

What do we do in the OR?


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