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Distal radius fracture
- 1. Insha Aleena Distal Radius Fracture
- 2. Anatomy Responsible for 80% of axial load of wrist. Articulates with: - Scaphoid - Lunate Main associations: 1. Radioulnar joint 2. Sigmoid notch 3. Lunate fossa 4. Scaphoid fossa
- 3. Watershed line: -most volar projection of distal radius -not covered by pronator quadratus -plate should not be placed beyond this line
- 4. Three Column Theory Lateral: scaphoid fossa and styloid process Intermediate: Lunate facet Medial: Ulna and TFCC
- 5. Normal Radiographic Measurements of Distal Radius Distal radio-ulnar joint congruity can be seen by the following measurements:
- 6. Radial Length Palmar Tilt Acceptable range: 10 to 12 mm Acceptable range: 11 to 12 degrees
- 7. Radial Inclination Ulnar Variance Acceptable range: 20 to 23 degrees Acceptable range: 0 to 2mm
- 9. Epidemiology of Distal Radius Fracture 1/6th of all fractures Trimodal distribution: -Paediatric (upto 14 years of age) -Women (>40 years of age) -Men (upto 50 years of age) Most common osteoporotic fracture
- 10. Clinical Features History of a fall onto outstretched hand (FOOSH) Wrist pain and swelling Wrist deformity Visible deformity if displaced Motion limited by pain Ecchymosis Diffuse tenderness
- 11. Types Colles fracture Smiths fracture Bartons fracture Chauffeurs fracture/Hutchinsons fracture Die punch fracture/lunate load fracture
- 12. Colles Fracture The most common type. It is a distal radius fracture in the wrist, has a characteristic backwards displacement of the hand. This fracture some times is referred to as dinner fork deformity, due to the shape of the fractured forearm. Dinner-fork Deformity
- 13. Smiths Fracture Is an extra articular transverse fracture that is palmarly displaced and can be thought of as a reverse Colles fracture. Distal fragment displaced in palmar (volar) direction with a "garden spade" deformity.
- 14. Other Radial Fractures Bartons Fracture: intra-articular fracture, dislocation or subluxation in which the rim of the distal radius, dorsally or volarly is displaced with the hand and carpus. Chauffeurs Fracture: intra-articular fracture involving the radial styloid, the radius is cleaved in a sagittal plane and the fragment is displaced proximally. Lunate Fracture: intra-articular fracture with displacement of the medial articular surface which usually represents a depression of dorsal aspect of lunate fossa.
- 17. Fernandezs Classification Bending- metaphysis fails under tensile stress (Colles, Smith). Extra-articular. Shearing- fractures of joint surface (Barton, radial styloid). Intra articular.
- 18. Compression - intra-articular fracture with impaction of subchondral and metaphyseal bone (die-punch). Complex articular fracture & radial pilon fracture. Avulsion- fractures of ligament attachments (ulna, radial styloid) Combined complex - high velocity injuries
- 19. Diagnosis and Imaging Radiographs Plain radiographs of an impacted distal radius A. Anteroposterior B. Lateral C. Oblique Acceptable radiographic parameters for a healed radius in an active healthy patient: Radial length: within 2-3mm of contralateral wrist. Palmar tilt: neutral tilt (0 degrees) Radial inclination: >15 degrees Intra-articular step-off: <2mm DRUJ congruent
- 20. CT indications: evaluate intra-articular involvement surgical planning MRI indications: evaluate for soft tissue injury -TFCC injuries -scapholunate ligament injuries (DISI) -lunotriquetral injuries (VISI)
- 21. Management Treatment depends upon:- 1. Patient factors: -Age -Functional needs -Occupation -Handedness 2. Fracture personality -Displaced/Undisplaced -Intra/extra articular -Reducible/irreducible -Stable/unstable 3. Associated injuries
- 22. Treatment Non-Operative: Closed reduction and splint/cast immobilisation. Operative: 1. Percutaneous pinning 2. External fixation 3. Plating 4. IMIL nailing Closed Reduction of Colles fracture
- 23. Operative Percutaneous pinning External Fixation
- 24. Plating IMIL nailing
- 25. Thank You