Distal radius fractures by recent last.pptx

This seminar presentation on distal radius fracture

1. DISTAL RADIU S FRACTURES B y : Dr. F ekadu . F ( MI ) M o d e r a t o r : Dr . Habtamu ( Orthopedic Surgeon )

2. Contents Introduction I ncidence Antomy of distal radius Clin ical features a n d Diagnosis An atomic landmarks and measurements Classification of distal radius fracture Options of management s Co mplications of Distal radius fractures

3. INTRODUCTION Distal radius fractures occur through the distal metaphysis of the radius. It may involve the articular surface - 5 % Most commonly results from a fall on the outstretched hand

4. INC IDENCE T he distal end radius fr a ctures account 16% of all fractures There are three main peaks of fracture incidence : Children aged 5-14 years Males under 50 years (high velocity) Females over 40 years of age (low velocity) Elderly – most commonly extra-articular Young – most commonly intra-articular

5. ANATOMY Di stal radius responsible for 80% of axia l load A rticulates with s caphoid
via scaphoid fossa L unate via lunate fossa Di stal ulna via ulnar/sigmoid notch

6. F alling onto their outstretch ed han d or sustain ing a blow to the wrist S wel ling, deformity, and evidence of a possible open fracture. NVS status, including motor and sensory function of the median, radial, and ulnar nerves Th e radial pulse and testing capillary refill R O M of the wrist ( supination, pronation, flexion, and extension ) Ix s : - Wri st X - ray ( AP, Lateral & Oblique views. ) Clin ical features

7. An atomic landmarks and measurements

8. GREA TER THAN 2mm articular step-off >10 degrees of dorsal tilt < 15 degrees of radial inclination Loss of radial height > 5mm Communition of both dorsal palmar cortices Irreducible fracture Loss of reduction after attempt to reduce. INDICATORS OF INSTABILITY

9. CLASSIFICATION Fractures of distal end radius are classified on the basis of : Presence or absence of intra-articular involvement Degree of comminution Dorsal or volar displacement Involvement of distal radio-ulnar joint

10. CLASSIFICATION Var ious eponyms are : Colle’s fracture Smith’s fracture Barton’s fracture Chauffer’s fracture / hutchinsons fracture

11. Colle’s fracture It is an extra-articular fracture of distal end of radius within 2cm from the articular surface The distal fragment is usually displaced dorsally.

12. Smith’s fracture/Reverse colle’s fracture O ccurs at the same level on the distal radius as a colles ' fracture. Distal fragment displaced in palmar (volar) direction

13. Barton’s fracture It is an intrarticular fracture dislocation T he distal radius dorsally or volarly is displaced with ra diocarpal unit There are 2 types Dorsal barton V olar barton Dorsal barton Volar barton

14. Chauffeur’s fracture/ hutchinson fracture It is an intra-articular fracture in volving the radial styloid , Isolated fracture of the radial styloid are fairly common from backfiring of starting handle of car

15. Common Classifications Gartland & Werley Frykman ( radiocarpal & radioulnar ) AO

16. Gartland & Werley Simple Colles fracture without intrarticular involvement Comminuted Colles ' fractures with intra-articular extension without displacement Comminuted Colles ' fractures with intra-articular extension with displacement Extra-articular, undisplaced

17. Frykman’s Classification Extra-articular Radio-carpal joint Radio-ulnar joint Both joints { Same pattern as odd numbers, except ulnar styloid also fractured Importance of sigmoid notch articular surface

18. AO classification

19. C lo sed reduction and apply spli n t . Analgesics Elev ate the arm B egin active range of motion of the shoulder and fingers. Apply ice to the fracture frequently Treatment

20. No noperative closed reduction and immobilization technique : Splinting, casting, and follow-up Indications e xtra-articular < 5mm radial shortening dorsal angulation < 5° or within 20° of contralateral distal radius

21. Technique of Reduction Analgesia — Several methods can be used to provide effective analgesia prior to reduction of distal radius fractures H ematoma (periosteal) blocks : - e ffective and s imple to perform P eripheral nerve blocks : - provide superior analgesia. I ntravenous regional anesthesia (Bier block)

22. Fi nger traps are a useful adjunct before the procedure is attempted. 2 to 5 kg of downward traction is placed on distal humerus for radi H elps to relax mu scle distract the fracture fragment s Brin g the radius closer to normal length

23. Follow up Non d isplaced Apply s plint for 1 w k Change to sho r t arm circular cast 1 w k follow-up Q2 - 3 wk until healing is complete R e m o v e cast 4 to 6 w k s Displaced Once reduction is achieved Keep spl i n t for 2 t o 3 w e e k s Take X-ray at post splint At 2 to 3 wks change to short arm cast Keep cast 6 to 8 wks R e move the cast ( evidence on x-r ay and non tender # site )

24. Complications Failure or loss of reduction Tendon adhesions and entrapement Carpal tunnel syndrome due to excessive palmar flexion

25. Surgical M anagement Externa l Fixation Joint-spanning Non bridging C losed reduction percutaneous pinning (CRPP) Internal Fixation Dorsal plating Volar plating Combined dorsal/volar plating focal (fracture specific) plating

26. External fixation Two types of external fixation Spanning external fixation Non-spanning external fixation

27. Indications open fractures highly comminuted fractures medically unstable patients unable to undergo a lengthy procedure

28. full finger motion

29. Complications Pin tract infection Finger stiffness Loss of reduction; early vs. late Tendon rupture

30. open reduction internal fixation (ORIF) In dications radiographic findings indicating instability (pre-reduction radiographs best predictor of stability) dorsal angulation > 5° or > 20° of contralateral distal radius v olar or dorsal comminution displaced intra-articular fractures > 2mm radial shortening > 5mm comminuted and displaced extra-articular fractures (Smith's fractures)

31. Complications Irritation Synovitis Tendon rupture

32. Co mplications of Distal radius fractures Early complications : A cute carpal tunnel syndrome, C ompartment syndrome, and V a scular compromise L ate complications : Chronic Regional Pain Syndro m N onunion Ma l-union Ne rve Injuries Tendon rupture Loss of range of motion

33. R eference Ortho Bullets UpToDates 2 2 4 Onlne

34. THANK YOU