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Distal Radius Fractures
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(Redirected from Distal Radius Fracture)
Other Names
- Distal Radius Fracture
- Radius Fracture
- Wrist Fracture
Background
- Overall, most common orthopedic injury representing 15-20% of all adult fractures [1]
- Defined as a fracture of the distal metaphysis or epiphysis with or without extension into the joint space.
Pathophysiology
- Anatomy
- Most commonly occurs due to a fall on outstretched hand (FOOSH)
Risk Factors
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
- Dislocations
- Wrist Dislocation (Radiocarpal and/or Ulnocarpal)
- Carpometacarpal Joint Dislocation
- Distal Radioulnar Joint Dislocation
- Lunate Dislocation
- Perilunate Dislocation
- Instability & Degenerative
- Tendinopathies & Ligaments
- Neuropathies
- Pediatric Considerations
- Distal Radial Epiphysitis (Gymnast's Wrist)
- Torus Fracture
- Arthropathies
- Cartilage
- Vascular
- Other
Clinical Features
- General: Physical Exam Wrist
- Tenderness, swelling, bruising at site of injury
- Deformity may or may not be present
Evaluation
Radiographs
CT Scan
- Evaluate for intra-articular involvement, surgical planning
MRI
- Evaluate for concurrent soft tissue injuries
Classification
- Several classification systems exist, no consensus on superiority
Management
Nonoperative
- Closed reduction to as anatomic as possible
- Indications for nonoperative management
- Extra-articular or stepoff < 2 mm
- < 5 mm of radial shortening
- Dorsal angulation < 5° or within 20° of contralateral distal radius
Operative
- Radiographic findings indicating instability (pre-reduction radiographs best predictor of stability)[2]
- Dorsal angulation > 5° or > 20° of contralateral distal radius
- Volar or dorsal comminution
- Displaced intra-articular fractures > 2mm
- Radial shortening > 5mm
- Associated ulnar fracture (associated ulnar styloid fractures do not require fixation)
- Severe osteoporosis
- Articular margin fractures (dorsal and volar Barton fractures)
- Comminuted and displaced extra-articular fractures (Smith's fractures)
- Die-punch fractures
- Progressive loss of volar tilt and loss of radial length following closed reduction and casting
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)
See Also
- Internal
- External
- Sports Medicine Review Wrist Pain: https://www.sportsmedreview.com/by-joint/wrist/
References
- ↑ Meena S, Sharma P, Sambharia AK, Dawar A. Fractures of distal radius: an overview. J Family Med Prim Care. 2014 Oct-Dec;3(4):325-32. doi: 10.4103/2249-4863.148101.
- ↑ https://www.orthobullets.com/trauma/1027/distal-radius-fractures