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Distal Radius Fractures

Distal Radius Fractures. Distal Radius Anatomy. Radial Styloid Lister’s Tubercle Ulnar styloid DRUJ. Radiographic Anatomy. Radial Inclination – 22 degrees Radial Ht – 11 mm Volar Tilt – 11 degrees Ulnar Varience. RADIAL Height (x) = ~ 11 – 12 MM; INCLINATION = ~ 22 0.

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Distal Radius Fractures

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  1. Distal Radius Fractures

  2. Distal Radius Anatomy • Radial Styloid • Lister’s Tubercle • Ulnar styloid • DRUJ

  3. Radiographic Anatomy • Radial Inclination – 22 degrees • Radial Ht – 11 mm • Volar Tilt – 11 degrees • Ulnar Varience

  4. RADIAL Height (x) = ~ 11 – 12 MM; INCLINATION = ~ 220 VOLAR TILT = ~ 110

  5. What is Ulnar Variance? Ulnar Negative Ulnar Positive

  6. Radiographic Anatomy • MRN 34611947 • Draw lines using PACS

  7. Fracture Subtypes of the Distal Radius • Colles • Smiths • Bartons – Volar and Dorsal • Chauffeur's Fracture

  8. Colles Fracture • Classically - low energy extra articularfrx of distal radiusoccuring in elderly individuals • dorsally displaced and angulated, apex volar • Mechanism - FOOSH • In extended position • dorsal surface undergoes compression while volar surface undergoes tension • Dorsal surface – communition!

  9. Colles Fracture - Clinical Appearance Dinner Fork Deformity

  10. Describe this fracture 07780539

  11. Smith’s Fracture (Reverse Colles) • Classically - extraarticular palmarly displaced, volar angulation (apex dorsal) distal radius frx • "Garden Spade" deformity • Mechanism – fall on flexed wrist

  12. Describe this fracture 02395796

  13. Barton’s Fracture • distal radius fracture w/ dislocation of radiocarpal joint • dislocation is the most striking radiographic finding • # involves – volar or doral rim/lip of distal radius • often occurs along with a radial styloid #

  14. Describe this fracture

  15. Chauffeur’s Fracture • radial styloid # • Mechanism - tension forces sustained during ulnar deviation and supination of the wrist • Radiocarpal ligaments avulse  radial styloid from metaphysis of the radius;    - ligamentous attachments maintains alignment radial styloid to carpus,  • Styloid displaced from the rest of radius by pull of brachioradialis

  16. Describe this fracture

  17. Intra-articular Fractures • Any of these fractures can be intra articular • Look for intra-articular steps • There are typical intra-articular fragments • Frykman Classification

  18. Describe 0589031-4

  19. Does this fracture need to be reduced? • Is fracture in acceptable position? • Radial Ht – 11 mm • Radial incline – 22 degrees • Volar Tilt – 11 degrees • IA Step < 1-2 mm • Ulnar variance – equal to other wrist • Is my reduction acceptable? • Use above criteria • Not acceptable? • Consider patient, consider OR

  20. How to do a reduction • Pain control • Ativan (relax the nervous), pain med (background pain control – morphine, tylenol) • Conscious sedation – IV fentanyl, midazolam • Hematoma block • “ouch block” • Tips • 1st CMC arthritis – change your grip • Watch out for thin skin

  21. How to do a Hematoma Block • Essentially - Just freeze the fracture site!! • Demonstration

  22. Reduction • Look at x-ray – come up with a reduction plan for every fracture! • Set-up • Finger Traps? • Assistants? • Solo? • How to do a reduction • Colles – cast in neutral and flexion • Smiths – cast in supination and extension • Demonstration – different methods, colles/smiths

  23. Casting • Tips • Stockingette? • Soft roll application • Plaster • Water temp • 3 point moulding • At fracture, NOT WRIST • Other moulding tips • Ulnar deviation

  24. Casting Complications • Acute Carpal Tunnel • Don’t hyperflex wrist – basically putting them in prolonged Phalen position

  25. Casting Complications • Compartment Syndrome • Avoid the tight cast! • If swelling a concern- bivalve your cast

  26. Late Complications • EPL Rupture • RDS • Malunion • Nonunion • Radiocarpal Arthrosis

  27. What do we do in the OR?

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