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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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Presentation Transcript
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
slide4

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!
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
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 #
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
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
slide18

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
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