common types distal radius


Description
Dr. Ebraheim’s educational animated video describes the common types of distal radius wrist fractures. Anatomy associated with distal radius fractures: - Radioulnar joint. - Sigmiid notch. - Lunate fossa. - Scaphoid fossa. The most common types of the distal radius fractures: - Colles fracture: • the most common type, • It is a distal radius fracture in the wrist, has a characteristic backwards displacement of the hand. • It’s a low energy fracture, extra articular fracture with dorsal displacement of the distal fracture fragment. • It typically occurs in patients more than 50 years old from attempting to break a fall with an outstretched hand. • This fracture some times is referred to as “dinner fork” deformity, due to the shape of the fractured forearm. • TFCC tears occurs in 50% of extra-articular distal radius fractures versus 1/3 of intra articular fractures. • Dorsal comminution is frequent and if comminution is to 50% of the dorsal cortex, then treatment with a cast will not work. The more dorsal flexion, then the more comminution and more chance of fracture failure when using a cast. • Colles fracture that extends to the DRUJ has a worse prognosis. - Smith fracture: • Is an extra articular transverse fracture that is palmarly displaced and can be thought of as a reverse Colles fracture. • It could occur from a fall onto a flexed wrist. • This fracture has multiple types: 1- Type I: fracture is extra articular transverse fracture through the distal radius (most common) 2- Type II: fracture crosses into the dorsal articular surface. 3- Type III: fracture enters the radiocarpal joint (volar barton fracture equals a Smith type III fracture), both will involve the intra- articular distal radius and includes possible dissociation of the carpal bones. - Die- Punch fracture: • Is a depressed fracture of the lunate fossa that results from axial loading forces on the distal radius that is transmitted through the lunate bone. • It is intra- articular fractures of the lunate fossa of the distal radius. • Check to see if there is any carpal bone dissociation. - Bartons fracture: • Intra articular fracture of the distal radius with dislocation of the radiocarpal joint. • These fractures can be dorsal or volar. • Check for carpal bone disruption or dissociation. • It is caused by a fall on an extended and pronated wrist with the volar type being the most common type. The fracture fragment is usually smaller with the dorsal barton fracture. • The volar barton fracture is the fracture of the volar margin of the of the distal radius, which is associated with subluxation of the radio-carpal joint. • The most striking finding is subluxation or dislocation of the wrist with that small fragment. • You can see in the picture the strong volar radiocarpal ligament avulses the volar lip of the radius. • This fracture is very similler to the Smith type III fracture. • Treatment of volar barton fracture is usually surgery with a volar approach and volar plate. • Dorsal Barton: the dorsal shearing force, distal radius fracture with dislocation of the radiocarpal joint, fracture ia intra-articular and involves the dorsal lip. Dislocation is the most striking x-ray finding. The avulsed fragment is usually small. Treatment is open reduction internal fixation through a dorsal approach. - Chauffer fracture: • Is fracture of the radial styloid process in association with scapholunate dissociation. • It is caused by compression of the scaphoid bone of the hand against the styloid process of the distal radius. • Evaluation of the radial styloid fracture should always include supinated view x-rays so that scapholunate dissociation can be ruled out. • Look for major swelling of the wrist and distal DISI deformity on lateral x-rays with a widening gap between the lunate and scphoid bones on AP view. • DISI deformity: the scapholunate angle is usually about 47° and can be up to 60°, any angle that is greater than 60° is considered abnormal; this is usually seen with a DISI deformity due to the palmar flexion of the scaphoid. This means that there is scaphoid dissociation. The scaphoid and lunate bones turn in opposite directions. • Treatment of this fracture is: compression screw fixation of the radial styloid process. • Assess the scapholunate joint for possible stabilization. In conclusion: - During assessment of the x-rays, you need to see if there is any involvement of the dorsal or volar rim of the radius. - Check for involvement of the DRUJ and look for die-punch lesions. - Check for dislocation of the wrist and the direction of the displacement. - Check the carpal distribution to see if there is any dissociation between the carpal bones.


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Related keywords:distal radius fracture DURJ ulnar styloid process extra-articular intra-articular classificaitons melone frykman AO fernadez hand wrist radius ulna fractures radioulnar joint scapholunate lunate scaphoid brachioradialis smith fracture colles chauffeur's die-punch barton's volar dorsal Dr. Nabil Ebraheim Nathan Elkins UTMC orthopaedics UT miranda simple easy diagnosis managment prognosis etiology treatment


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