Distal radius fractures: Difference between revisions
No edit summary |
No edit summary |
||
| Line 1: | Line 1: | ||
==Types== | |||
==Differential Diagnosis== | |||
{{Forarm fracture DDX}} | {{Forarm fracture DDX}} | ||
==Colles | ==[[Colles fracture]]== | ||
===Background=== | ===Background=== | ||
*Distal radial metaphysis fx that is dorsally displaced and angulated | *Distal radial metaphysis fx that is dorsally displaced and angulated | ||
| Line 32: | Line 35: | ||
**Immediate ortho referral | **Immediate ortho referral | ||
==Smith | ==[[Smith fracture]]== | ||
===Background=== | ===Background=== | ||
*Volar angulated fx ("reverse Colles fracture" or "garden-spade deformity") | *Volar angulated fx ("reverse Colles fracture" or "garden-spade deformity") | ||
| Line 43: | Line 46: | ||
*Similar to Colles fracture | *Similar to Colles fracture | ||
==Barton | ==[[Barton fracture]]== | ||
===Background=== | ===Background=== | ||
*Dorsal or volar rim fx | *Dorsal or volar rim fx | ||
| Line 60: | Line 63: | ||
**Accompanying carpal subluxation | **Accompanying carpal subluxation | ||
==Radial | ==[[Radial styloid fracture]]== | ||
===Background=== | ===Background=== | ||
*Often accompanied by lunate dislocation | *Often accompanied by lunate dislocation | ||
| Line 86: | Line 89: | ||
==See Also== | ==See Also== | ||
*[[Forearm | *[[Forearm fractures]] | ||
==Source== | ==Source== | ||
Revision as of 22:01, 29 December 2014
Types
Differential Diagnosis
Forearm Fracture Types
- Distal radius fractures
- Radia ulna fracture
- Isolated radius fracture (proximal)
- Isolated ulna fracture (i.e. nightstick)
- Monteggia fracture-dislocation
- Galeazzi fracture-dislocation
- Forearm fracture (peds)
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
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
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
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
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
Management
- Dorsal dislocation
- Immobilize wrist in supination
- Volar dislocation
- Immobilize wrist in pronation
See Also
Source
- Tintinalli