Transcript Fractures of the distal radius

Fractures of the distal radius
Colles` fracture
This fracture is described by Ibraham colles`
in 1814 .
It is a transverse fracture of the distal end of
the radius with posterior displacement of
the distal fragment.
It is the most common of all fractures in the
human being ; mainly in old osteoporotic
people , but it occur in all age groups .
It is occur due to fall on out stretched hands
Clinically :
The deformity of this fracture called dinner – fork
deformity .
The patient also has the sign and symptoms of any
other fracture like pain , tenderness , loss of
function , swelling …..etc .
X-ray : there is transverse fracture of the
radius at the cortico – cancellous
junction , and the distal fragment is
displaced posteriorly ; some time it is severely
comminuted or crushed .
Treatment :
It must be reduced under general
anesthesia, the reduction will be by
traction on the hand in the length of the
bone , the distal fragment then pushed into
place by pressing on the dorsum while
manipulating the wrist into flexion , ulnar
deviation and pronation
Then put back slab and check by x-ray .
The back slab from below elbow to the neck
of the metacarpals .
Extreme pronation , flexion and ulnar
deviation must be avoided ; 20` in each
direction is adequate .
Shoulder and fingers exercise then started .
After 7-10 days remove the slab and do full
p.o.p. . The fracture usually unite in 6 weeks
Complication : early : 1-vascular damage
radial artery (rare) .
2- nerve damage median nerve (rare) .
Late complication :
1- malunion : it is common due to
unreduced fracture or due to
redislpacement .
2- delayed union and non union .
3-stiffness of the wrist ,fingers, elbow and shoulder
4-tendon rupture of extensor polices longus .
5- sudeck`s dystrophy (localized sympathetic over
activity).
6-carpal- tunnel syndrome .
Smith fracture :it is the same as colles` fracture but the
Radial styloid process fracture :
Here the fracture line extend from the articular
surface of the radius laterally .
Treatment :
If there is displacement , the fracture should be
reduced by manipulation under anesthesia ,
then back slab below elbow tell the neck of the
metacarpal ; imperfect reduction will lead to
osteoarthritis , so if the fracture not reduced
perfectly by manipulation then open reduction
and fixation by screw or k wire .
BARTON`S FRACTURE
It is intra articular fracture of the lower end of the radius
with subluxation of the wrist joint .
It is of two types :
1- volar Barton's`: called true Barton fracture and
it associated with volar subluxation of
the carpus . The fracture line run obliquely across the
volar lip of the radius into the wrist joint . The distal
segment displaced anteriorly carrying the carpus with it .
Treatment : the fracture easily reduced but it is unstable so
it can easily redisplaced so the treatment will
be by open reduction and fixation by special plate called
Buttress plate .
2- dorsal Barton`s: it is the reverse of the volar one .
Fracture scaphoid bone
It is caused by fall on out stretched hands ;
the most important point in scaphoid is its
blood supply inter the bone from distal to
proximal direction , so the blood supply is
decreased from distal to proximal ; this
fact explain why only 1% of the fracture in
the distal third of scaphoid , 20% of the
fract. In the middle third and 40% of the
proximal third fract. Will develop avascular
necrosis and non union .
Clinically : there is fullness and tenderness in
the
anatomical snuff box ; other diagnostic
sign is that, proximal pressure along the axis of
the thumb is painful .
X-ray : a-p , lateral and oblique views are all
essentials . Some time recent fracture
show it self only in oblique view .
Usually the fracture is transverse and through the
narrowest part of the bone (the waist) , but it
could be in the proximal pole or in the tubercle ;
few weeks after injury the fracture will be more
obvious
Fracture scaphoid
If union is delayed , cavitation appear on
either side of the fracture .
In old ununited fracture there will be
sclerosis at the edge and the appearance
will be as there is extra carpal bone .
Sclerosis of the proximal fragment is path
gnomonic of avascular necrosis of the
proximal fragment .
Treatment :
Undisplaced fracture : conservative
treatment by p.o.p. cast in 90% of
the cases will heal ; the cast will be applied from upper
forearm to just short of the metacarpophalangeal joint of
the fingers but it should incorporating the proximal
phalanx of the thumb ; the wrist is held in dorsiflexion
and the thumb forward in ( GLASS HOLDING ) position
and it should be retained for 6 weeks .
After 6 weeks the p.o.p. removed and the wrist examined
clinically and radiologically , if there is no tenderness and
the x-ray show sign of healing , the wrist is left free
If there is local tenderness or the fracture is still
visible in x-ray , the p.o.p. is reapplied for further
6 weeks and after that either the wrist become
painless and the fracture healed so the p.o.p.
removed or the x-ray show sign of delayed
healing then we should do fixation and bone
grafting .
Displaced fracture : treatment by open
reduction and fixation by
compression screw .
Complication
1- avascular necrosis :
the proximal fragment may die especially
with proximal pole fracture , it will appear
dense on x-ray .
Treatment : by excision of the proximal
fragment .
2- non union : after 3 months if fracture not
united it will be obvious that the fracture will not
unite at all .
Treatment :in old people and in those who are completely
asymptomatic , non union may be left untreated .
In young patients treatment by fixation and bone grafting .
non union fracture scaphoid
Avascular necrosis of proximal
segment of scaphoid frac.
If the graft fail then do excision of the
scaphoid and fusion of the carpel bones .
3- osteoarthritis :
non union and avascular necrosis may
lead to secondary osteoarthritis .