Distal radius fractures

Background

Left arm, anterior view of radius and ulna.

Left arm, posterior view of radius and ulna.

• Definition: Fracture at the metaphysis or the articulation of the distal radius
• One of the most common fractures seen in the ED (1/6th of all fractures treated)

Distal radius fractures

• Colles' fracture
• Smith's fracture
• Barton's fracture
• Radial styloid fracture
• Distal radioulnar joint disruption

Distal radius fracture eponyms

Eponyms	Description
Barton's	Fracture-dislocation of radiocarpal joint (with intra-articular fracture involving the volar or dorsal lip)
Chauffer's	Fracture of radial styloid
Colles'	Dorsally displaced, extra-articular fracture
Die-punch	Depressed fracture of the lunate fossa (articular surface)
Smith's	Volar displaced, extra-articular fracture

Clinical Features

Classic "dinner fork" deformity.

Distal radius fracture demonstrating the deformity in the wrist.

• Commonly from a fall on an outstretched wrist that is dorsiflexed
• Wrist/forearm trauma and pain
• Possible forearm deformity

Exam Pearls

• Perform full neurovascular assessment of the hand (including median, ulnar, and radial nerves
• Examine ipsilateral elbow, shoulder, and hand

Differential Diagnosis

Forearm Fracture Types

• Distal radius fractures
  • Colles' fracture
  • Smith fracture
  • Barton fracture
  • Radial styloid fracture
  • Distal radioulnar joint disruption
• Radia ulna fracture
• Isolated radius fracture (proximal)
• Isolated ulna fracture (i.e. nightstick)
• Monteggia fracture-dislocation
• Galeazzi fracture-dislocation
• Forearm fracture (peds)

Evaluation

Colles' fracture, one type of distal radius fracture.

Volar Barton's fracture, one type of distal radius fracture.

Displaced, intra-articular distal radius fracture.

Workup

• Forearm x-ray AP and lateral

Diagnosis

• Typically from plain forearm x-rays

Management

General Fracture Management

• Acute pain management
• Open fractures require immediate IV antibiotics and urgent surgical washout
• Neurovascular compromise from fracture requires emergent reduction and/or orthopedic intervention
• Consider risk for compartment syndrome

Acute Reduction

• Indications:
  • Most angulated and/or displaced distal radius requires closed reduction and placement of a sugar-tong splint
  • Consider even if operative management is expected (to reduce pain and swelling)
• Steps:
  1. Adequate analgesia (e.g. morphine and/or hematoma block)
  2. highly consider procedural sedation
  3. Axial traction: Manual or finger traps with hanging weights, if available
  4. Recreate, then reverse, mechanism of injury
     • Although recreating the injury briefly exaggerates the existing deformity, this maneuver "unlocks" any periosteal sleeve folded into the fracture site (which can be critical in achieving reduction)
     • Continue to maintain axial traction throughout manuver
     • For example with a fracture with dorsally angulated fragments, establish axial traction, then slightly bending the dorsal fragment even more dorsally while maintain traction, then reverse pressure to reduce the distal fragment volarly and back out to length, all while maintaining traction.
  5. Splint
  6. Re-image
• Goal:
  • Always target optimal (anatomic) fracture reduction
  • Operative fixation is recommended for fractures with post-reduction:
    • Radial shortening > 3mm
    • Dorsal tilt > 10°, or
    • Intra-articular displacement or step-off > 2mm

Splinting

• Reduction performed
  • Sugar tong splint
• Reduction not attempted or failed
  • Volar short arm splint
    • If severe pain with pronation/supination, then sugar tong splint

Disposition

• Most can be treated with orthopedic follow up within 1 week

Admit

• Open fracture
• Neuro-vascular compromise
• Risk or concern for compartment syndrome
• Patient is unable to function at home (e.g. uses walker with that arm)

See Also

• Forearm fractures

External Links

• https://www.orthobullets.com/trauma/1027/distal-radius-fractures