Reverse deformity is seen in volar angulation Smith's fracture. The wrist may be radially deviated due to shortening of the radius bone. Decreased sensation over the thenar eminence can be due to median nerve injury. Swelling and displacement can cause compression on the median nerve which results in acute carpal tunnel syndrome and requires prompt treatment. Very rarely, pressure on the muscle components of the hand or forearm is sufficient to create a compartment syndrome.
Nonunion is rare; almost all of these fractures heal. Malunion , however, is not uncommon, and can lead to residual pain, grip weakness, reduced range of motion especially rotation , and persistent deformity. Symptomatic malunion may require additional surgery. Half of nonosteoporotic patients will develop post-traumatic arthritis, specifically limited radial deviation and wrist flexion. This arthritis can worsen over time. Nerve injury, especially of the median nerve and presenting as carpal tunnel syndrome, is commonly reported following distal radius fractures.
Tendon injury can occur in people treated both nonoperatively and operatively, most commonly to the extensor pollicis longus tendon. This can be due to the tendon coming in contact with protruding bone or with hardware placed following surgical procedures. The cause for this condition is unknown. The most common cause of this type of fracture is a fall on an outstretched hand from standing height, although some fractures will be due to high-energy injury.
People who fall on the outstretched hand are usually fitter and have better reflexes when compared to those with elbow or humerus fractures. The characteristics of distal radius fractures are influenced by the position of the hand at the time of impact, the type of surface at point of contact, the speed of the impact, and the strength of the bone.
Distal radius fractures typically occur with the wrist bent back from 60 to 90 degrees. If the wrist is bent back less, then proximal forearm fracture would occur, but if the bending back is more, then the carpal bones fracture would occur. With increased bending back, more force is required to produce a fracture. More force is required to produce a fracture in males than females. Risk of injury increases in those with osteoporosis. Common injuries associated with distal radius fractures are interosseous intercarpal ligaments injuries, especially scapholunate 4.
There is an increased risk of interosseous intercarpal injury if the ulnar variance the difference in height between the distal end of the ulna and the distal end of the radius is more than 2mm and there is fracture into the wrist joint. Ulnar styloid process fracture increases the risk of TFCC injury by a factor of However, it is unclear whether intercarpal ligaments and triangular fibrocartilage injuries are associated with long term pain and disability for those who are affected.
Diagnosis may be evident clinically when the distal radius is deformed, but should be confirmed by X-ray. The differential diagnosis includes scaphoid fractures and wrist dislocations, which can also co-exist with a distal radius fracture.
Occasionally, fractures may not be seen on X-rays immediately after the injury. X-ray of the affected wrist is required if a fracture is suspected. Posteroanterior, lateral, and oblique views can be used together to describe the fracture. A CT scan is often performed to further investigate the articular anatomy of the fracture, especially for fracture and displacement within the distal radio-ulnar joint.
Various kinds of information can be obtained from X-rays of the wrist: . There are many classification systems for distal radius fracture. There are three major groups: A—extra-articular, B—partial articular, and C—complete articular which can further subdivided into nine main groups and 27 subgroups depending on the degree of communication and direction of displacement.
However, none of the classification systems demonstrate good liability. A qualification modifier Q is used for associated ulnar fracture. Correction should be undertaken if the wrist radiology falls outside the acceptable limits: . Treatment options for distal radius fractures include nonoperative management, external fixation, and internal fixation. Indications for each depend on a variety of factors such as the patient's age, initial fracture displacement, and metaphyseal and articular alignment, with the ultimate goal to maximize strength and function in the affected upper extremity.
Treatment is often directed to restore normal anatomy to avoid the possibility of malunion, which may cause decreased strength in the hand and wrist. Distal radius fractures are often associated with distal radial ulnar joint DRUJ injuries, and the American Academy of Orthopaedic Surgeons recommends that postreduction lateral wrist X-rays should be obtained in all patients with distal radius fractures in order to preclude DRUJ injuries or dislocations.
The majority of distal radius fractures are treated with conservative nonoperative management, which involves immobilization through application of plaster or splint with or without closed reduction. Variations in immobilization techniques involve the type of cast, position of immobilization, and the length of time required in the cast.
For those with low demand, cast and splint can be applied for two weeks. In those who are young and active, if the fracture is not displaced, the patient can be followed up in one week. If the fracture is still undisplaced, cast and splint can be applied for three weeks. If the fracture is displaced, then manipulative reduction or surgical stabilisation is required. Shorter immobilization is associated with better recovery when compared to prolonged immobilization.
Therefore, follow up within the first week of fracture is important. Subsequent follow ups at two to three weeks are therefore also important. Where the fracture is undisplaced and stable, nonoperative treatment involves immobilization.avidalagyr.tk
Initially, a backslab or a sugar tong splint is applied to allow swelling to expand and subsequently a cast is applied. However, an above-elbow cast may cause long-term rotational contracture.
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However, neutral and dorsiflex position may not affect the stability of the fracture. In displaced distal radius fracture, in those with low demands, the hand can be cast until the person feels comfortable. If the fracture affects the median nerve , only then is a reduction indicated. If the post reduction radiology of the wrist is acceptable, then the person can come for follow up at one, two, or three weeks to look for any displacement of fractures during this period.
If the reduction is maintained, then the cast should continue for 4 to 6 weeks. If the fracture is displaced, surgical management is the proper treatment. Therefore, periodic reviews are important to prevent malunion of the displaced fractures. Closed reduction of a distal radius fracture involves first anesthetizing the affected area with a hematoma block , intravenous regional anesthesia Bier's block , sedation or a general anesthesia. The deformity is then reduced with appropriate closed manipulative depending on the type of deformity reduction , after which a splint or cast is placed and an X-ray is taken to ensure that the reduction was successful.
The cast is usually maintained for about 6 weeks. Failure of nonoperative treatment leading to functional impairment and anatomic deformity is the largest risk associated with conservative management. Prior studies have shown that the fracture often redisplaces to its original position even in a cast. In people over 60, functional impairment can last for more than 10 years. Visit our Osteoporosis category page for the latest news on this subject, or sign up to our newsletter to receive the latest updates on Osteoporosis.
All references are available in the References tab. Desai, P. Colles fracture.
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Distal radius fractures broken wrist. Hand and wrist injuries and conditions.
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Colles fracture: What you need to know
Optional Comments max. Send securely. Message sent successfully The details of this article have been emailed on your behalf. Reviewed by William Morrison, MD. Colles fracture describes a broken wrist. It is characterized by the bone pointing upwards, and being around 1 inch from the thumb. Image credit: Ashish j29, October. Symptoms of a Colles fracture may include the wrist appearing deformed, and hanging in an unnatural position. Image credit: Sylvain Letuffe, July.
Greenstick fractures - Diagnosis and treatment - Mayo Clinic
Latest news Morning people may have lower breast cancer risk. Accessed March 21, Kliegman RM, et al. Common fractures. In: Nelson Textbook of Pediatrics. Schweich P. Distal forearm fractures in children: Diagnosis and assessment. Mencio GA. Fractures and dislocations of the forearm, wrist and hand. In: Green's Skeletal Trauma in Children.
Mathison DJ, et al. General principles of fracture management: Fracture patterns and description in children. March 21, Distal forearm fractures in children: Initial management. Closed reduction and casting of distal forearm fractures in children. Herring JA.
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