2.5 Wrist Fractures Flashcards
In a normal wrist there two angles/lines that are easily disrupted by a fracture. What are they?
normal radial inclination of 25degrees
normal volar tilt of 10 degrees
(radius is usually long by 2mm at the distal radio ulnar joint - the DRUJ where they touch)
What are three patterns of distal radius fracture?
Colle’s
Barton’s
Smith’s
How do you get a Colle’s fracture and what are the 4 characteristics?
From a fall on outstretched hand “FOOSH”
- dorsal angulation
- radial inclination flattened
- radial shortening/ impaction
- extra-articular fraction with 4cm of the joint line
Often quite marked visible deformity
Management of Colle’s fracture
Displaced fracture should be manipulated with traction and plaster applied.
Anaesthetise with haematoma block or a Bier’s block.
Conservative management can be tried.
Unstable fractures may need open reduction and internal fixation. (DVR plate)
What happens in a Smiths fracture?
opposite to Colle’s - a fall onto a flexed wrist, less common.
- radial flattening and impaction
- volar displacement rather than dorsal
More unstable than Colle’s so usually need open reduction and internal fixation.
What happens in a Barton’s fracture?
Intra-articular distal radius fracture and is described both with dorsal and volar displacement.
- significant subluxation and sometimes dislocation of the radiocarpal joint.
Unstable, will need surgery.
Starting at the edge off that radius and going across and back again, what are the carpal bones?
Proximal row: Scaphoid, lunate, triquetral, pisiform
Distal row:
Hamate, capitate, trapezoid, trapezium
How do you get a Scaphoid fracture?
Similar mechanism to Colle’s
Account for 2/3rds of carpal fractures.
Notoriously difficult to diagnose as they are undsiplaced so hard to see on an xray.
Keep high degree of clinical suspicion.
How do you diagnose a scaphoid fracture?
Clinical examination 3 steps:
- press the anatomical snuffbox
- telescope the thumb (pressure seafood via trapezium)
- press the scaphoid tubercle
If based of that you suspect scaphoid fracture then request a ‘scaphoid series’ from xray. Four different angles.
How do you treat suspected / confirmed scaphoid?
immobilisation in a ‘thumb spica’
2 week follow up out of plaster and repeat scaphoid series and clinical exam.
Most can be managed conservatively however proximal pole of scaphoid is particularly at risk of non-union and may be fixed. Still no healing may need further surgery and bone grafting.
