- See:
-
Distal Radius Frx Menu:
-
Intra-Articular Fractures of the Distal Radius:
- General Discussion:
- frx was described by Abraham Colles in 1814, originally described as low energy extra articular frx of distal radius occuring in elderly individuals;
- frx is typically dorsally displaced and angulated;
-
mechanism:
- fracture is also caused by a forced dorsiflexion of the wrist;
- occurs in pts > 50 years of age who fall on out stretched hand;
- dorsal surface undergoes compression while volar surface undergoes tension;
-
classification:
-
Frykman Classification
-
Melone Classification
-
Universal Classification
-
associated injuries:
-
TFCC tear
- according to the report by Richards et al 1997 et, TFCC tears occurred in 53% of extra-articular distal radius fractures vs 35%
of
intra-articular fractures;
-
scapholunate dissociation:
-
Intercarpal Ligament Injuries Associated with Fractures of the Distal Part of the Radius
- Physical Exam and Evaluation:
- Radiographic Findings:
- x-ray appearance is that of a dorsally angulated fracture of distal radial metaphysis
(2-3 cm proximal to wrist joint),
w/ or w/o associated frx of
ulnar styloid;
- initial frx line is almost always on volar side & is single line;
-
determination of stability:
-
intra-articular component:
-
radial shortening:
-
dorsal angulation:
-
radial inclination:
-
distal radioulnar subluxation and/or
ulnar styloid frx
- in stable extra-articular fractures, there will often be frx extension into the
DRUJ, which is the most likely source of symptoms;
-
scapholunate dissociation:
- ref: Scapho-Lunate Diastasis: A Component of Fractures of the Distal Radius. Mudgal-CS. Jones-WA. J Hand Surg. 1990. 15-B. pp 503-505.
-
comminution:
- dorsal surface is frequently comminuted;
- if comminution extends volar to midaxial plane of radius, then cast immobilization will frequently fail;
- expect increase in comminution w/ incr in amount of dorsiflexion;
- high-loading angles, (70-90 deg), have much more comminution than low loading angles of 20 to 40 deg;
- as noted in the study by Trumble et al 1998, external fixation provided clear advantages in specific situations;
- in older patients, pain relief, grip strength, and ROM were significantly better when external fixation was used;
- in younger patients, external fixation provided consistently better results when there was comminution in 2 or more cortices;
- references:
-
An effective treatment of comminuted fractures of the distal radius.
- Intrafocal (Kapandji) pinning of distal radius fractures with and without external fixation.
TE Trumble et al. J. Hand Surg. Vol 23-A. No 3. May 1998. p 381.
- Treatment:
-
Colles Fracture Reduction: (see:
position of immobilization);
-
Percutaneous Pinning
-
External Fixators for Distal Radius Fractures:
-
ORIF of Intra-Articular Distal Radius Fractures:
- ref:
A Randomized Prospective Study on the Treatment of Intra-Articular Distal Radius Frx: ORIF w/ Dorsal Plating vs
Mini Open Reduction, Percutaneous Fixation, and External Fixation.
- Late Complications:
-
extensor pollicis longus rupture:
-
RSD
- often RSD following colles fractures will result from over distraction of an external fixator;
- in the presentation by D Stoffelen and PL Broos (15 th Annual Meeting of the Orthopaedic Trauma Association 1999), the authors found
use of
calcitonin to be helpful in treating this disorder;
- vitamin C:
Can Vitamin C Prevent Complex Regional Pain Syndrome in Patients with Wrist Fractures?
- loss of reduction and secondary deformity;
-
median nerve compression;
-
malunion:
-
distal radioulnar joint injury;
- extension of Colles frx into the RU joint has a worse prognosis;
- in stable extra-articular fractures, there will often be frx extension into the
DRUJ, which is the most likely source of symptoms;
- patients may note:
- weak grip;
- localized pain;
- loss of supination;
- ref: The Distal Radio-Ulnar Joint in Colle's Fracture. GS Roysam. JBJS 75-B, 1993. p 58-60.
- Refernces
