Chauffers Fracture

Other Names

• Chauffeur's Fracture
• Hutchinson Fracture
• Backfire Fractures

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Background

• This page refers to Chauffer's fracture which is defined as an itra-articular fracture of the radial styloid process

History

• Name related to started a hand crank car which would occasionally result in the crank rapidly spinning backwards out of the driver's grasp and striking the back of the wrist

Epidemiology

• Prevalence, incidence poorly defined in the literature

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Pathophysiology

• Anatomy
  • Primarily distal Radius
  • Can also involve Scaphoid, Lunate, Ulna
• Mechanism
  • Direct blow to the back of the wrist
  • Forced dorsiflexion with abduction
• Potential co-occurring injuries
  • Scapholunate Instability
  • Perilunate Dislocation
  • Ulnar Styloid Fracture

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Risk Factors

• Osteoporosis

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Differential Diagnosis

Distal Radius Fractures

• Barton's Fracture
• Chauffer's Fracture
• Colles' Fracture
• Die-Punch Fracture
• Radial Styloid Fracture
• Smith's Fracture

Differential Diagnosis Wrist Pain

• Fractures
  • Distal Radius Fracture
    • Barton's Fracture
    • Chauffer's Fracture
    • Colles' Fracture
    • Die-Punch Fracture
    • Radial Styloid Fracture
    • Smith's Fracture
  • Distal Ulna Fracture
  • Carpal Fractures
    • Scaphoid Fracture
    • Lunate Fracture
    • Triquetrum Fracture
    • Pisiform Fracture
    • Trapezium Fracture
    • Trapezoid Fracture
    • Capitate Fracture
    • Hamate Fracture
  • Essex Lopresti Fracture
• Dislocations
  • Wrist Dislocation (Radiocarpal and/or Ulnocarpal)
  • Carpometacarpal Joint Dislocation
  • Distal Radioulnar Joint Dislocation
  • Lunate Dislocation
  • Perilunate Dislocation
• Instability & Degenerative
  • Scapholunate Instability
  • Lunotriquetral Instability
  • Scaphoid Nonunion Advanced Collapse
  • Distal Radial Ulnar Joint Instability
  • Kienbocks Disease
  • Dorsal Wrist Impingement
• Tendinopathies & Ligaments
  • De Quervain's Tenosynovitis
  • Intersection Syndrome
  • TFCC Injury
  • Wrist Tendinopathies
  • Extensor Carpi Ulnaris Instability
• Neuropathies
  • Carpal Tunnel Syndrome
  • Pronator Teres Syndrome
  • Anterior Interosseus Nerve Syndrome
  • Posterior Interosseus Nerve Syndrome
  • Guyon Canal Syndrome
• Pediatric Considerations
  • Distal Radial Epiphysitis (Gymnast's Wrist)
  • Torus Fracture
• Arthropathies
  • Wrist Osteoarthritis
  • Rheumatoid Arthritis
  • Gout
• Cartilage
  • Osteochondral Defect
• Vascular
  • Hypothenar Hammer Syndrome
• Other
  • Ganglion Cyst of Wrist
  • Ulnar Impingement Syndrome
  • Infectious Tenosynovitis

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Clinical Features

• General: Physical Exam Wrist
• Pain, swelling, ecchymosis in wrist
• Deformity may or may not be present depending on degree of displacement

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Evaluation

PA Wrist - Chauffer's Fracture

Radiographs

• Standard Radiographs Wrist initially
• Sufficient to make diagnosis
• Fracture typically extends through lateral cortex of distal radius separating radial styloid
• Fracture fragment may not be displaced

CT Scan

• Evaluate for intra-articular involvement, surgical planning

MRI

• Evaluate for concurrent soft tissue injuries

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Classification

• Exists, although not commonly used

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Management

Nonoperative

• Acceptable closed reduction
  • < 2mm articular stepoff
  • < 5mm shortening
  • < 10° dorsal tilt

Operative

• Surgical Indications
  • Radial shortening > 3 mm
  • Dorsal tilt > 10º
  • Intra-articular displacement
  • Step-off > 2 mm

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Return to Play

• Needs to be updated

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Complications

• Median Nerve Neuropathy
• Ulnar Nerve Neuropathy
• EPL Rupture
• FPL Rupture
• Radiocarpal Arthropathy
• Malunion or Nonunion
• ECU or EDM Entrapment
• Acute Compartment Syndrome
• RSD/ CRPS
• Distal Radioulnar Joint Disruption
• TFCC Injury
• Scapholunate Instability (DISI)
• Lunotriquetral Instability (VISI)

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See Also

• Internal
  • Forearm Pain (Main)
  • Wrist Pain (Main)
  • Hand and Wrist Anatomy (Main)
  • Physical Exam Wrist
• External
  • Sports Medicine Review Wrist Pain: https://www.sportsmedreview.com/by-joint/wrist/

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