Distal Radius Fractures
Kathryn Ashley Bentley
Nileshkumar M. Chaudhari
Fracture of the distal end of the radius that originates in the metaphyseal region and often extends into the radiocarpal and distal radioulnar joints (DRUJs)
Most common fracture seen in the emergency department
3% of all upper extremity injuries
Incidence of 640 000 annually in the United States1
Distal radius is the articular surface on which the carpus rests.
Metaphysis of the distal radius is primarily cancellous bone.
Sigmoid notch (DRUJ)
80% of axial load is supported by the distal radius and 20% by the ulna and triangular fibrocartilage complex (TFCC).3
Mechanism of injury
Younger individuals—falls from height, motor vehicle collisions, injury sustained during athletic participation
Older individuals—lower energy mechanisms such as falls from standing height
Fall on an outstretched hand with the wrist in 40° to 90° of dorsiflexion results in a distal radius fracture with dorsal displacement.4
Volar side of radius initially fails in tension and then the fracture propagates dorsally where bending moment forces cause compression stresses that result in dorsal comminution.
Fall on the back of the flexed hand or fall on a forearm in supination followed by pronation around a fixed extended wrist5
Shearing forces influence injury patterns as well as often resulting in articular surface involvement.3
Lunate can exert compressive forces on the distal radius, producing a die-punch fracture.4
Up to 68% of distal radius fractures are associated with soft tissue injuries.
Scapholunate ligament injury
Median nerve injury8
Identification of associated traumatic injuries
Physiologic patient age and comorbidities
Skin should be inspected for any compromise.
Swelling, ecchymosis, and tenderness to palpation about the wrist
Deformity of the wrist is common.
Careful neurovascular examination should be performed with particular attention to median nerve function.
Ipsilateral elbow and shoulder should also be examined for associated injuries.
Radiographs of the elbow, forearm, wrist, and hand
Posteroanterior and lateral views of the wrist should be obtained.
CT scanning may help with fracture characterization.3
Open versus closed, displacement, angulation, comminution, loss of radial length
Colles fracture (Figure 26.4A and B)
Extra-articular/intra-articular distal radius fractures demonstrating various combinations of dorsal angulation, dorsal displacement, radial shift, and radial shortening with associated ulnar styloid fracture
“Dinner fork” deformity clinically
More than 90% of distal radius fractures
Mechanism of injury is fall onto hyperextended, radially deviated wrist with the forearm in pronation.
Reverse Colles fracture
Fracture with volar angulation of the distal radius with volar displacement of the hand and distal radius
Very unstable fracture pattern
Mechanism of injury is a fall onto a flexed wrist with the forearm fixed in supination.
Fracture—dislocation/subluxation of the wrist in which the dorsal or volar rim of the distal radius is displaced with the hand and carpus.
Very unstable fracture pattern
Mechanism of injury is a fall onto an extended wrist with the forearm fixed in pronation.
Chauffeur fracture (radial styloid fracture)
Avulsion fracture with extrinsic ligaments remaining attached to the styloid fragment
May involve entire styloid or only the dorsal/volar portion
Often associated with carpal ligament injury patterns (ie, perilunate dislocations)
Frykman classification of Colles fractures
Type I: extra-articular without distal ulna fracture
Type II: extra-articular with distal ulna fracture
Type III: intra-articular involving radiocarpal joint without distal ulna fracture
Type IV: intra-articular involving radiocarpal joint with distal ulna fracture
Type V: intra-articular involving DRUJ without distal ulna fracture
Type VI: intra-articular involving DRUJ with distal ulna fracture
Type VII: intra-articular involving radiocarpal and DRUJ without distal ulna fracture
Type VIII: intra-articular involving radiocarpal and DRUJ with distal ulna fracture
Melone classification of intra-articular fractures (lunate impaction injury)
Four major fragments of the distal radius fractures are identified:
Dorsal medial facet
Volar medial facet10
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