Distal radius fractures: Difference between revisions
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==[[Colles' fracture]]==
==[[Colles' fracture]]==
===Background===
*Distal radial metaphysis fx that is dorsally displaced and angulated
**Fracture line may extend into radioulnar or radiocarpal joint ("die-punch" fx)
*Occurs due to FOOSH
*Ulnar styloid fx is often present and suggests injury to TFCC
===Clinical Features===
*Characteristic dorsiflexion or "dinner-fork" deformity
*Palmar paresthesias (pressure on median nerve)
===Imaging===
*PA
**Distal metaphyseal fx that often appears shortened from angulation or comminution
*Lateral
**Provides best view of dorsal angulation and comminution
[[File:Colles fracture.JPG|thumb|Colles fracture]]
===Management===
*Assess for instability:
**>20 degrees angulation
**Intra-articular involvement
**Marked comminution
**>1cm shortening
*Stable Fracture
**Compression dressing and sugar tong splint
**Closed reduction may be attempted
*Unstable Fracture
**Immediate ortho referral


==[[Smith fracture]]==
==[[Smith fracture]]==
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===Imaging===
===Imaging===
*Similar but opposite to Colles fracture
*Similar but opposite to Colles fracture
==Differential Diagnosis==
{{Distal radius fracture DDX}}


===Management===
===Management===
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*Lateral
*Lateral
**Intra-articular fx of volar or dorsal rim of radius
**Intra-articular fx of volar or dorsal rim of radius
==Differential Diagnosis==
{{Distal radius fracture DDX}}


===Management===
===Management===
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**Volar or dorsal displacement of ulna (which is usually centered/overlapping the radius)
**Volar or dorsal displacement of ulna (which is usually centered/overlapping the radius)
**Requires a true lateral to avoid a false positive result
**Requires a true lateral to avoid a false positive result
==Differential Diagnosis==
{{Distal radius fracture DDX}}


===Management===
===Management===

Revision as of 22:06, 29 December 2014

Types

Distal radius fractures

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

Differential Diagnosis

Forearm Fracture Types

Colles' fracture

Smith fracture

Background

  • Volar angulated fx ("reverse Colles fracture" or "garden-spade deformity")
  • Occurs due to fall or direct blow to dorsum of hand/wrist

Imaging

  • Similar but opposite to Colles fracture

Differential Diagnosis

Distal radius fractures

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

Management

  • Similar to Colles fracture

Barton fracture

Background

  • Dorsal or volar rim fx
  • Often is fx-dislocation or subluxation because carpus is displaced in direction of the fx

Imaging

  • PA
    • Communiuted fx of distal radial metaphysis
  • Lateral
    • Intra-articular fx of volar or dorsal rim of radius

Differential Diagnosis

Distal radius fractures

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

Management

  • Minimally displaced: sugar tong splint and ortho referral
  • Unstable requires ORIF
    • >50% of radial articular surface
    • Accompanying carpal subluxation

Radial styloid fracture

Background

  • Often accompanied by lunate dislocation
  • Often assoc w/ carpal instability (carpal ligaments insert on the radial styloid)

Management

  • Short arm splint; position wrist in mild flexion and ulnar deviation

Distal Radioulnar Joint Disruption

Background

  • Seen w/ intra-articular or distal radial shaft fractures or both bone fracture

Imaging

  • PA
    • Narrowing and overlap of distal radioulnar joint
  • Lateral
    • Volar or dorsal displacement of ulna (which is usually centered/overlapping the radius)
    • Requires a true lateral to avoid a false positive result

Differential Diagnosis

Distal radius fractures

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

Management

  • Dorsal dislocation
    • Immobilize wrist in supination
  • Volar dislocation
    • Immobilize wrist in pronation

See Also

Source

  • Tintinalli
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