T&O: Distal Radial Fractures

Question 1

what is the most common type of fracture in the elderly?

Answer 1

Colles fracture (90% of all distal radial fractures) - high incidence related to onset of post-menopausal osteoporosis.

Question 2

describe the differences between Colles fracture and Smith’s fracture?

Answer 2

Colles fracture:

• Hx of FOOSH
• extra-articular transverse fracture of distal radius, with dorsal angulation and dorsal displacement of distal fragment
• ‘dinner fork’ deformity

Smith’s fracture:

• Hx of fall onto flexed wrist or direct injury to back of wrist
• transverse fracture of distal radius, with volar angulation +/- volar displacement of distal fragment
• ‘garden spade’ deformity

Question 3

how would you manage a Colles or Smith’s fracture?

Answer 3

• maj. treated with closed reduction and immobilisation (for Colles fracture: cast extends from elbow to metacarpal heads and holds wrist somewhat flexed and ulnar deviated)
• ORIF considered if fracture is unstable or unsatisfactor closed reduction

Question 4

suggest possible complications of Colles fracture

Answer 4

1. malunion - resulting in dinner fork deformity
2. median n. palsy and post-traumatic carpal tunnel syndrome
3. complex regional pain syndrome
4. secondary OA
5. EPL tendon tear

Question 5

suggest possible complications of Smith’s fracture

Answer 5

1. malunion - resulting in garden spade deformity

2. median n. palsy and post-traumatic carpal tunnel syndrome

Question 6

what is Barton’s fracture and how is it managed?

Answer 6

Intra-articular oblique fracture of distal radius with associated dislocation of radio-carpal joint.

X-ray features:

• oblique radial fracture line running from volar surface of distal radius into wrist joint
• fragment often displaced anteriorly, carrying carpus with it as a fracture-dislocation

Management: ORIF (using small anterior buttress plate), usually recommended as often unstable and easily re-displaced.

Question 7

what is Chauffeur’s fracture?

Answer 7

Intra-articular fracture of radial styloid process

Question 8

what is a Galeazzi fracture-dislocation?

Answer 8

Fracture of radial shaft (between middle and distal third) with dorsal angulation + dislocation of distal radio-ulnar joint.