Distal radius fracture. June 17 2009 Asim Makhdom. Epidemiology. Frequency 17% of all ER visits . Distal radial fractures account for 1/6 of all fractures seen in the ED Race: No racial preferences have been reported. Age Bimodal age distribution:
June 17 2009
Bimodal age distribution:
Peaks at ages 5-14 years and at ages 60-69 years.
Elderly patients extra-articular, metaphyseal
Young patients intra-articular fractures with joint surface displacement.
In older postmenopausal women, female-to-male ratio 4:1 but In adolescent boys and girls, the ratio is 3:1
Low energy trauma: FOOSH
In young adult, injury usually is as result of high energy trauma & results in comminuted, intraarticular injuries
Tension on the volar cortex, comminution of the dorsal cortex, and ligamentous injury
injury should be evaluated for:-
Wrist PA, Lat, and oblique
AP and lat. Of the contralateral wrist
Andersen et al compared the Frykman, Melone, Mayo, and AO/ASIF classification systems and concluded that a low degree of intraobserver and interobserver agreement exists in each of these 4 systems.
pain free, mobile and stable wrist.
Graham1997(Jaaos) 1_Radial shortening less than 5 mm at the distal radioulnar joint (DRUJ) compared with the contralateral wrist.
2_Radial inclination of more than 15° on a posteroanterior (PA) image.
3_Sagittal tilt on the lateral projection between 15° dorsal tilt and 20° volar tilt.
2mm or more of articular incongruity led to post-traumatic arthritis
Malunion/ non union
DRUJ Complicatios ( Incongruent DRUJ)
Medial, Ulnar, Complex regional pain syndrome
(3) Is there a particular techniquefor each treatment modality that provides superior results?
Recent randomized, controlled trials have begun to clarify someof these questions!!
Kreder et al.(JOT)2006 .When validated outcome scores were used to comparespanning external fixation with closed reduction and cast immobilizationof metaphyseal displacment(DRF) without joint incongruity in 113patients, SF -36bodily pain scores and (MFA) scores at two years favored external fixation.
Harley et al. 2004(JHS)
similar validated outcome scores and functionaloutcomes at one year, the patients treated with ex/fixdemonstrated better articular congruity on radiographic follow-up.
Indirect reduction and percutaneous fixation versus open reduction and internal fixation for displaced intra-articular fractures of the distal radius
Bridging external fixation and supplementary Kirschner-wire fixation versus volar locked plating for unstable fractures of the distal radius