Flashcards in Distal Radius Fractures Deck (15):
What percentage of distal radius fractures are intra-articular?
50%; radial styloid fractures indicate higher energy mechanism
What are the radiographic norms and acceptable displacements in distal radius fractures?
radial height- 11mm
radial inclination- 23°
volar tilt- 11°
radial height- with 2-3mm of contralateral wrist
radial inclination- Change of
What are LaFontaine's criteria for distal radius fractures?
1) Dorsal angulation >20
2) Dorsal comminution >50%, Palmar comminution, Intra-articular comminution
3) Initial displacement >1cm
4) Initial radial shortening >5mm
5) Associated ulnar fracture
6) Severe osteoporosis
Patients with 3 or more factors have high chance of loss of reduction. Among these variables radial shortening is the most predictive of instability followed by dorsal comminution.
In treating distal radius fractures spanning external fixation does not correct what deformity?
In volar locked plating of a distal radius fracture what is the most common tendon rupture?
FPL; up to 12%
When should a carpal tunnel release be performed in a distal radius fracture?
1) Complete median n. injury
2) Progressive median n. parasthesias
3) Parasthesias do not improve or worsen with reduction
What tendon rupture is associated with non-displaced distal radius fractures?
EPL; 3-5% of non-displaced fxs treated non-operatively
0.3% in those treated with ORIF
Treat with an EIP to EPL transfer
What deformity is associated with greatest loss of wrist function and degenerative changes in extra-articular distal radius fxs?
Loss of radial height
The Shuck test is performed after fixation of the distal radius to assess the status of the DRUJ, which ligaments are tested?
The radioulnar; Excessive sagittal plane ulnar translation signifies DRUJ injury.
In a comminuted distal radius fracture, which fragment may need fragment specific fixation?
Small distal volar lunate-facet fragment; distal volar lunate fragment is the site of origin of the strong volar radiolunate ligaments which insert onto the lunate, and so displacement of this small piece volarly will allow the lunate and the rest of the carpus to subluxate volarly
What are the reduction maneuvers for distal radius fractures during ORIF?
Traction- restores length
Palmar translation- restores volar tilt
Slight pronation and ulnar deviation- corrects common supination deformity
Whats the regimen when casting distal radius fractures?
1) Can place in short arm or long arm cast in supination or neutral
2) Follow weekly with xrays for three weeks; always compare to first reduction film
3) Cast for 6-8 weeks total
What is the interval for the volar Henry approach to the distal radius?
Floor of the FCR sheath;
btw the FCR and radial a.; FPL is retracted ulnarly then the pronator quadratus is excised and retracted ulnarly as well; brachioradialis can be sharply dissected from radial styloid;
What are indications for the use of a dorsal spanning bridge plate in distal radius fractures?
1) high-energy injuries
2) fracture extension into the radius and ulnar diaphysis,
3) multiple extremity injuries who require load bearing for mobilization.