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Mechanism Of Injury Children and old women: low energy trauma : simple fracture Young adult: high energy trauma : comminuted, intraarticular fracture... Specific fracture types 1773-1843

DISTAL RADIUS

FRACTURE

Lê Ngọc Quyên

Anatomy

ATO

2 inches (5cm) ATO

Mechanism Of Injury

Children and old women: low energy trauma : simple fracture

Young adult: high energy trauma :

comminuted, intraarticular fracture

Radiographic Assessment

Extensor carpi ulnaris tendon groove

Smithuis:

Supination/Pronation 10 0

DA changes 5 0

Intra-articular gap or step

inclination, ulnar inclination…)

DA : Dorsal angulation(volar tilt, palmar tilt, dorsal tilt…)

RA RL DA UV

Graham 22 0 12mm 11 0 -2mm LNQ 23 0 11mm 9 0 -0.8mm

P<0.05

Specific fracture types

(1773-1843), Irish surgeon and anatomist)

Smith’s

Colles’ fracture

Specific fracture types

Volar displacement (Robert William Smith

(1807-1873), Irish surgeon)

Barton's:

Smith’s fracture

Specific fracture types

Radial rim fracture with dislocation of the radiocarpal joint (can be dorsal or volar);

John Rhea Barton (1794-1871) American

surgeon

Chauffeur's:

Volar Barton’s fracture Dorsal Barton’s fracture

Specific fracture types

Radial styloid :

Chauffeur’s fracture

Specific fracture types

Lunate load fracture : “Die punch” fracture

Classifications

displacement and severity of fracture

prognosis

Many classfication systems: Frymann,

Fernandez, Melon, AO…

Fernandez classification: Fractures of distal radius classified by mechanism of injury I, Bending II, Shear III, Impaction IV, Avulsions with fracture-dislocation V, High velocity

Frykman's classification Types I, III, V, and VII do not have

an associated fracture of the distal ulna Fractures III through VIII

Columnar classification

AO classification

Treatment Goals

Criteria for acceptable reduction

Graham 1997 Radial shortening : < 5 mm

Predictors of stability (AO)

( unstable fracture)

• Dorsal comminution exceeding >50% of the

dorsal to palmar distance

• Palmar metaphyseal comminution

• Initial dorsal angulation > +20°

• Initial displacement (fragment translation) >1 cm

Treatment options

intraarticular fracture

Closed reduction and cast immobilization

Closed / Open reduction and percutaneous pinning

Kapandji intrafocal technique

Dorsal approach Volar approach

ORIF with plate fixation (+/- pinning)

External fixation (+/- pinning)

External fixation + pinning + Grafting bone

Pre op After closed reducion +EF: 3mm articular step

Grafting bone+pinning 2 years Post Op

there is persistent gap deformity along the entire fracture line, with a displacement of 2 mm

fluoroscopic views after reduction and fixation,

suggesting an good anatomic articular reduction

Arthroscopically assisted reduction and

fixation of intraarticular fracture

2 Which of the following is true regarding the external fixation?

a relies on ligamentotaxis to maintain reduction

b usually combined with percutaneous pinning

technique or plate fixation

c cannot reliably restore dorsal angulation

d all above

3 A 32-year-old worker sustains a distal radius fracture Radiographs are provided below What is the appropriate treatment?

a Closed reduction and long cast

b Closed reduction and percutaneous pinning

c Open reduction and plate fixation

d Open reduction and external fixation

Anwser:

1 D

2 D

3 C