Distal forearm fractures and dislocations

1. Distal forearm fractures and dislocations Dr. Ihab Rassem Lecturer of Radiology Ain Shams University Cairo, Egypt

2. Radiography • PA & Lateral are sufficient in most cases

5. Radiographic anatomy

6. Neutral Ulnar variance

7. Negative Positive

8. Ulnar slant of articular surface of radiusMeasured on PA view

9. Palmar inclination angleMeasure on Lateral view

10. Fracture types • Colles Fracture • Smith Fracture • Barton fracture • Hutchinson fracture • Essex-Lopresti fracture dislocation • Galeazzi fracture dislocation

11. Colles Fracture • Most frequently encountered injury to the distal forearm. • Fall on the outstretched hand with forearm pronated in dorsiflexion. • Age usually above 50y; F>M. • Extraarticular 2-3 cm away from articular surface of radius. • Associated # of ulnar styloid process

15. Smith Fracture • Fracture of the distal radius with volar displacement and angulation of the distal fragment • Results from a fall on the back of the hand or a direct blow to the dorsum of the hand. • Often referred to as a reverse Colles fracture.

16. Smith Fracture

17. Barton Fracture • Fracture of dorsal margin of the distal radius extending into the radiocarpal articulation. • Reverse (or volar) Barton fracture: when it involves the volar aspect of distal radius

18. Barton Fracture

19. Reverse Barton

20. Hutchinson Fracture • Also known as chauffeur's fracture. • Involves the lateral margin of the distal radius, extending through the radial styloid process into the radiocarpal articulation . • Best seen in PA view

21. Hutchinson Fracture

22. Essex-Lopresti Fracture-Dislocation Complex type injury which comprises • Comminuted fracture of the radial head and neck +/- distal extension. • Tear of the interosseous membrane. • Dislocation in the distal radioulnar joint.

26. Galeazzi Fracture–Dislocation This injury type comprises:- • Fracture of the distal third of the radius, • Dislocation in the distal radioulnar joint.

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