Distal radius fracture

Distal radius fracture by Dr Bipul Borthakur

1. DISTAL RADIUS FRACTURE DR. BIPUL BORTHAKUR PROFESSOR , DEPT OF ORTHOPAEDICS, SMCH

2. INTRODUCTION - Anatomy

3. FRACTURES OF DISTAL RADIUS Colle’s fracture Smith fracture Barton’s fracture Chauffeur’s fracture

4. COLLES’ FRACTURE Described by Abraham Colles in 1814 It’s the fracture at the corticocancellous junction of the distal radius , 2.5 cm proximal to the distal articular surface of the radius, with typical displacement Commonly seen in elderly female patients: post-menopausal osteoporosis Mechanism of injury – fall on the outstretched hand with wrist in extension

5. COLLES’ FRACTURE Displacements in Colles’ fracture Shifts – Dorsal and lateral Tilts – Dorsal and lateral Impaction or proximal shift Supination Associated injuries: Ulnar styloid fracture Rupture of ulnar collateral ligament Rupture TFCC (triangular fibrocartilage complex) Rupture of the interosseous radio-ulnar ligament – DRUJ subluxation

6. COLLES’ FRACTURE CLINICAL FEATURES: Pain, swelling and external deformity – DINNER FORK DEFORMITY Limited ROM of wrist, tenderness Radial styloid rides upward to lie at the same level or a little higher than the ulnar styloid process

7. COLLES’ FRACTURE INVESTIGATIONS: Plain radiograph of forearm with elbow & wrist – AP and lateral view Dorsal tilt is the characteristic displacement – in lateral view Lateral tilt – in AP view Both can be diagnosed in x-ray – articular surface faces dorsally or neutral in lateral view, faces laterally or horizontal in AP view.

8. COLLES’ FRACTURE TREATMENT: Undisplaced fracture – below elbow cast immobilization without any manipulation With typical displacement – closed manipulation and below elbow slab or cast immobilization for 4 to 6 weeks. Traction and counter-traction: disimpaction Correction of dorsal tilt – palmar flexion Correction of radial tilt – ulnar deviation

9. COLLES’ FRACTURE TREATMENT: Final position of C olles’ cast Pronation of forearm Palmar flexion Ulnar deviation Take a check x-ray after Colles’ cast application to confirm the reduction Repeat x-rays at 7, 14 and 21 days (fracture becomes sticky) to see for redisplacement .

10. COLLES’ FRACTURE TREATMENT: Patient advised to keep the limb elevated Shoulder, elbow and finger joint movements have to be emphasized Remove the cast immediately if signs of compartment syndrome develops Fracture heals by 6 weeks, following which physiotherapy has to be started

11. SMITH’S FRACTURE Reverse C olles’ fracture – ventral tilt and shift Fall on the outstretched hand with wrist in flexion Volar tilt / shift instead of dorsal tilt / shift More unstable than Colles’ fracture Garden-spade deformity

12. SMITH’S FRACTURE Plain x-ray of wrist confirms the diagnosis Treatment – closed manipulation + B/E slab or cast for 6weeks Traction – supination – extension of the wrist Surgical fixation if fracture displaces again – volar locking plates

13. BARTON’S FRACTURE High energy injury Intra-articular fracture of distal radius Either with volar or dorsal displacement Highly unstable fracture Demands restoration of articular congruity, alignment and length.

14. BARTON’S FRACTURE Plain x-ray AP, lateral and oblique views; CT scans are useful Usually operative treatment CR or OR with percutaneous K-wires OR with volar locking plates Distractor application in highly comminuted fractures

15. CHAUFFEUR’S FRACTURE It is an intra-articular fracture of radial styloid process. It results due to fall on outstretched hand. It can be managed conservatively.

16. COMPLICATIONS OF DISTAL RADIUS FRACTURE Early: Nerve injury – median nerve compression Complex regional pain syndrome (CRPS) or Sudeck’s osteodystrophy Ulnar corner pain and instability Associated injuries of the carpus Redisplacement

17. COMPLICATIONS OF DISTAL RADIUS FRACTURE Late: Malunion – due to improper reduction, improper fixation and redisplacement Delayed union and non-union – rare unless infected or severe bone loss with instability Tendon rupture – EPL, FPL Carpal instability – due to ligament injury Secondary osteoarthritis – in intra-articular fractures

18. THANK YOU