Distal radius fractures

Diagnosis

Is there loss of normal anatomy (e.g. fx displacement or angulation, loss of radial height)
Is there involvement of the radiocarpal or distal radioulnar joint?
Is there discontinuity of the articular surface or diastasis (separation) of the articular fragments?
Are high-risk features present (severe comminution, articular step-off >2 mm, fracture-dislocation)?

PA
Radial inclination (angle between line perpendicular to long axis of radius and line between radial styloid and ulnar corner of lunate fossa)
Normal = 15-25 degrees
Often smaller with fx
Radial height (Distance between distal tip of radial styloid and articular surface of the radius)
Normal ~ 10-17mm
Often smaller with comminuted or impacted fx
Ulnar variance (Distance between ulnar-side articular surface of radius and the ulnar carpal surface)
Normally 1-2mm
Lateral
Palmar Tilt (angle between line perpendicular to long axis of radial shaft and line through the apices of the palmar and dorsal rims of the radius
Normally 10o-25o
Often smaller with fx
Oblique
May reveal intra-articular involvement not seen on other views

Colles' Fx
Dorsal displacement of the distal radius fragment
Smith's Fx
Palmar displacement of distal radius fragment
Hutchinson's Fx
Radial styloid avulsion +/- lunate or scapholunate dissocation
Galeazzi Fx
Radial shaft Fx + dislocation of the distal radioulnar joint (ulna positive variance)
Barton's Fx-dislocation
1. Palmar Barton's
Radial avulsion + palmar displacement of radiocarpal unit
2. Dorsal Barton's
Radial avulsion + dorsal displacement of radiocarpal unit

Immediate reduction only required for neurovascular invovlement
Nondisplaced extra-articular fx
Relatively stable
Sugar tong, reverse sugar tong, or double sugar tong splint
Elbow flexed to 90o, arm in neutral position
Displaced fx
Splint, arrange next-day f/u; reduction by experienced clinician is appropriate, but not required
Adequate reduction:
No dorsal tilt of the distal radial articular surface
Less than 5 mm of radial shortening
Less than 2 mm of displacement of fracture fragments

Refer all of the following:
Palmarly displaced fx
Articular step-off >2mm
Large ulnar styloid fx with displaced fragments at the styloid base
Fracture dislocations
Distal radius fractures associated with scaphoid fractures or scapholunate ligament injuries
Fractures with significant displacement or comminution
Unstable fx
Greater than 20 degrees of dorsal angulation
Fracture displacement in any direction greater than two-thirds the width of the radial shaft
Metaphyseal comminution with more than 5 mm of radial shortening
Ulnar variance greater than 5 mm compared with the contralateral wrist (normal variance is 0 to -2 mm
Intraarticular component (especially involving the DRUJ)

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