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Orthopaedics + MSK > Distal radial fractures > Flashcards

Distal radial fractures Flashcards

1
Q

What % if all fractures seen clinically do distal radial fractures represent?

A

25%

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2
Q

Where do distal radial fractures occur?

A

Through the distal metaphysis of the radius

With or without articular involvement

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3
Q

What is the most common cause of a distal radial fracture?

A

Fall on an outstretched hand (FOOSH)

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4
Q

What are the risk factors for distal radius fractures?

HINT: think about risk factors for osteoporosis

A

Osteoporosis

Increased age (as risk of osteoporosis increases)

Children aged between 5-15 years

Female gender

Early menopause

Smoking/alcohol excess

Prolonged steroid use

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5
Q

What % of the axial load does the distal radius take?

A

80% of the axial load under the scaphoid and lunate fossae

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6
Q

What type of movement and subsequent injury of the distal radius does FOOSH cause?

A

Forced supination or pronation of the carpus

Increases the impaction load of the distal radius

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7
Q

What are the different classifications of distal radius fractures?

A

Colles’ fracture

Smith’s fracture

Barton’s fracture

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8
Q

What is Colles’ fracture?

A

Extra-articular fracture of distal radius

With dorsal angulation and dorsal displacement

Within 2cm of the articular surface

Typically occurs as a fragility fracture in osteoporotic bone

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9
Q

What causes a Colles’ fracture?

A

Falling forward with outstretched arms in from

Transfer of load as the body falls forces the wrist into supination

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10
Q

What is a Smith’s fracture?

A

Volar angulation of the distal fragment of an extra-articular fracture of the distal radius

i.e., the reverse of a Colles’ fracture)

With or without volar displacement

Less common

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11
Q

What causes a Smith’s fracture?

A

Falling backwards and planting the outstretched hand behind the body

Causes a forced pronation

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12
Q

What is a Barton’s fracture?

A

Intra-articular fracture of the distal radius
+
Dislocation of the radio-carpal joint

Can be described as volar (more common) or dorsal (less common) - depends on whether the volar or dorsal rim of the radius is involved

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13
Q

What are the clinical features of a distal radius fracture?

A

Episode of trauma

Immediate pain +/- deformity

Sudden swelling around fracture site

Neuro involvement = paraesthesia or weakness

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14
Q

What is important to check in examination of someone with suspected distal radius fracture?

A

Neurovascular compromise

Check nerve function of median, ulnar and radial nerve?

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15
Q

How would you check the nerve function of the median nerve?

A

Motor - abduction of the thumb

Sensory - radial surface of 2nd digit or top of the palmar surface of 3rd digit

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16
Q

Which nerve branches from the median nerve? How would you check its function?

A

Anterior interosseous nerve

Opposition of the thumb and index finger

17
Q

How would you check the nerve function of the ulnar nerve?

A

Motor - abduction of the thumb (Froment’s sign)

Sensory - ulnar surface of the distal 5th digit

18
Q

What is the Froment’s sign?

A

Tests strength of the abductor pollicis muscle

Innervated by the ulnar nerve and weakened in ulnar nerve palsy

19
Q

How would you test for the Froment’s sign?

A

The patient is asked to make a strong pinch between the thumb and index finger and grip a flat object such as a piece of paper between the thumb and index finger

The examiner then attempts to pull the object out of the subject’s hands.

There is weakness of the adductor pollicus innervated by the ulnar nerve which would keep the IP joint relatively straight

Instead, the FPL muscle which is innervated by the median nerve is substituted for the AP and will cause the IP joint to go into a hyperflexed position

20
Q

How would you check the nerve function of the radial nerve?

A

Motor - extension of IPJ of thumb

Sensory - dorsal surface of 1st webspace

21
Q

What are the DDx for distal radius fractures?

A

Forearm fracture e.g., Galeazzi or Monteggia fractures

Carpal bone fractures

Tendonitis or tenosynovitis

Wrist dislocations

22
Q

Which investigation would you do?

A

Plain radiography

CT/MRI - complex fractures esp. for operative planning

23
Q

What 3 measurements on plain radiography help with Dx of a distal radius fracture?

A

Radial height < 11mm

Radial inclination < 22 degrees

Radial (volar) tilt > 11 degrees

24
Q

How would you manage?

A

Resuscitate and stabilise

Closed reduction - traction and manipulation under anaesthetic

Restriction - allow for bone healing

Stable + successfully reduced fractures can be placed in below-elbow backslab cast - repeat radiographs after 1 weeks to check for displacement

Once bone healed, rehabilitate via physiotherapy to ensure full regaining of function

25
Q

When would you require surgical Mx?

A

Significantly displaced

Unstable fractures

As they have a risk of displacing further over time if not stabilised

Any fracture with an intra-articular step of the radiocarpal joint > 2mm

26
Q

What are the options for surgical Mx?

A

Open reduction and internal fixation (ORIF) with plating

K-wire fixation

External fixation rarely used

Patient then placed in a cast to ensure ongoing immobility for a few weeks

27
Q

What are the main complications of a distal radius fracture?

A

Malunion - poor realignment leads to shortened radius compared to ulnar

Median nerve compression - more common in patients who heal in a significant degree of malunion

Osteoarthritis - especially with intra-articular involvement from the original fracture

28
Q

What can malunion cause apart from radial shortening?

A

Reduced wrist motion

Wrist pain

Reduced forearm rotation

29
Q

How can malunion be treated?

A

Corrective osteotomy - cuts bone to restore normal alignment

30
Q

What is the typical sign of a Colles fracture?

A

Dinner fork deformity a.k.a. bayonet deformity

Malunited distal radial fracture

Distal fragment is dorsally angulated, displaced and often impacted

31
Q

What is the typical sign of a Smith’s fracture?

A

Garden spade deformity

32
Q

In someone that presents with a possible Colle’s fracture, apart from the hand what else would you want to examine?

A

The shoulder

Due to impact on falling

33
Q

Sources

A

https://teachmesurgery.com/orthopaedic/wrist-and-hand/distal-radius-fracture/

https://www.physio-pedia.com/Froment%E2%80%99s_Sign

https://radiopaedia.org/articles/smith-fracture?lang=gb

https://radiopaedia.org/articles/dinner-fork-deformity-wrist?lang=gb

Orthopaedics + MSK (6 decks)

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