broken wrist - distal radius fractures

When the radius breaks near the wrist, it is called a distal radius fracture.
Colles fracture, which produces a very distinctive sign known as the “dinner fork deformity.” Viewed from the side, the wrist has the appearance of an overturned fork.
Numbness and/or inability to move the wrist or hand
Bruising of the wrist and forearm
Extra-articular fracture - A fracture that does not extend into the joint .
A Colles’ fracture which is a fracture of the distal radius within 2cm of the articular surface , with posterior displacement of the distal fragment . the patient’s forearm and hand resemble the curvature of a dinner fork.
A Smith fracture.it is the reverse of a Colles fracture .
the distal fragment typically shifts down toward the palm side.
An intra-articular fracture is one that extends into the wrist joint.
Barton’s Fracture which is a fracture in the coronal plane of the radius that extends into the wrist joint.
A Barton fracture can be volar or dorsal , depending on whether the volar or dorsal rim of the radius is involved.
There is usually associated dorsal subluxation/dislocation of the radiocarpal joint in the direction of the fracture fragment.
Chauffeur fractures are intra-articular fractures of the radial styloid process.
Die-punch fracture is a depressed fracture of the lunate fossa of the articular surface of the distal radius
When a fractured bone breaks the skin, it is called an open fracture.
When a bone is broken into more than two pieces, it is called a comminuted fracture.
Displaced vs. nondisplaced. These terms describes whether the bones or fragments have moved out of place or are still in place.
A greenstick fracture occurs when a bone bends, instead of breaking completely into separate pieces.
Three important measurements can be determined, using the x ray
Radial inclination: Usually 21°-25°
Volar tilt. Normally 11°-12° volar.
Radial height . Normally 11-12 mm.
these measurements are often abnormal when a fracture of the distal radius is present.
Acceptable criteria for distal radius fractures
Radial height: Less than 5 mm shortening
Radial inclination: Less than 5-degree change
Articular step off: Less than 2 mm
Volar tilt: Dorsal angulation less than 5 degrees or within 20 degrees of the contralateral distal radius
If the fracture is in a good position, a splint or cast is simply applied until the bone completely heals.
closed reduction and splint/cast immobilization
Post-reduction radiographs must be obtained to evaluate the quality of the reduction.
Should the acceptable criteria not be met or If the reduction is not maintained and is no longer acceptable, surgical intervention should be recommended.
There are various methods of fixation, including pins, external fixators, dorsal plates, and a volar plate or Any combination of these techniques
Percutaneous pinning is useful in in extra-articular fractures with a stable volar cortex. It is unacceptable when the volar cortex is comminuted, and therefore unstable, as there is not enough bony fixation to maintain reduction. The pins will be removed in a few weeks, once healing of the fracture is evident and/or the cast is removed.
Open-reduction internal fixation with plating is typically necessary for displaced intra-articular fractures more than 2mm, Barton's fractures, die-punch fractures, severe osteoporosis, volar or dorsal comminution, comminuted and displaced extra-articular fractures and if the pre-reduction radiographs indicates instability
External fixation is used for open fractures, highly comminuted fractures or for medically unstable patients unable to undergo a lengthy procedure. it is usually combined with percutaneous pinning technique or plate fixation
the wrist will be in a splint for 10 days to allow pain and swelling to subside.
It is essential to limit the duration of external fixation to a maximum of 8 weeks and to perform aggressive hand therapy to maintain range of motion of the hand.
The wrist and arm should be functional for most activity by 8 to 10 weeks after surgery.
After about 3 to 6 months, most patients can resume heavier wrist or arm activity and sports.
Full distal radius fracture recovery generally takes about a year.
complex regional pain syndrome (reflex sympathetic dystrophy)
Malunion of the bone and continued deformity , it can be treated with corrective osteotomy of the malunion
tendon damage from an internal plate, a second surgery may be needed to correct this problem.
Post-traumatic arthritis in the wrist (particularly with intra-articular fractures)
Residual pain and stiffness
Median nerve compression, more common in patients who heal in a significant degree of malunion
Pin-site or incision infections
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