Lower radius fractures

Colles fracture Transverse fracture of the radius just above the wrist with dorsal displacement of distal fragment. It is most common fractures in older people.

epidemiology Most common fractures of the upper extremity Common in younger and older patients. Usually a result of direct trauma such as fall on out stretched hand Increasing incidence due to aging population

Mechanism of Injury Most commonly a fall on an outstretched extremity with the wrist in dorsiflexion High energy injuries may result in significantly displaced, highly unstable fractures dorsal angulation (apex volar), dorsal displacement, radial shift, and radial shortenting of distal fragment.

Clinical Evaluation Patients typically present with gross deformity (dinner- fork) of the wrist with variable displacement of the hand in relation to the wrist. Typically swollen with painful ROM Ipsilateral shoulder and elbow must be examined NV exam including specifically median nerve for acute carpal tunnel compression syndrome

Clin. Feat.

Radiographic Evaluation 3 view of the wrist including AP, Lat, and Oblique Normal Relationships

X-ray

Treatment 1-undisplaced fractures: Treated by application of dorsal splint for 4weeks. 2-displaced fractures: Reduction under local anaesthesia (biers block, axillary block) is done by manipulating the wrist into flexion, ulnar deviation, and pronation.

Treat. Then cast is applied in 20 deg. Of ulnar dev. And flexion. the cast applied for 7-10 days then x-ray taken, if satisfactory position, we change it to p.o.p. for 6 weeks. 3-comminuted fractures: Either treated by casting or by percutaneous K0wires. In severely comminuted fracture we use external fixation.

Complications Early: 1-circulation. 2-nerve injury. 3-reflex sympathetic dystrophy. 4-TFCC. Injury.

Compl. Late 1- malunion. 2- delayed union. 3- stiffness. 4- tendon rupture.

Smith fracture Just opposite to colles fracture, due to fall on the dorsum of the hand, with anterior displacement of distal end with forward shift and anterior angulation (garden spade deformity)

Treatment Fracture reduction done by traction and extension of the wrist then cast application for 6 weeks.

Barton's fracture subluxation Similar to smith fracture but involves articular surface of the wrist joint (the fracture extend through joint) There are to types of Barton's fracture (volar and dorsal). There is subluxation and even dislocation of the wrist joint.

Treatment Trial of closed reduction is done ,with casting .but most of the cases needs open reduction internal fixation.

Scaphoid fracture Scaphoid fracture accounts for almost 75perc. Of all carpal fractures . Its rare in elderly and children.

Mechanism of injury A fall on adorsiflexed hand. the distal fragment flexes and the proximal fragment tilts dorsally. The blood supply of Scaphoid comes from distal to proximal , so any fracture through its waist well cut the blood supply to proximal part.

Clinical features There is fullness of anatomical snuffbox and precisely localized tenderness on same place. Also proximal pressure along the axis of the thumb may be painful.

X-ray A.P, lateral and oblique views should be taken. often recent fracture shown only by oblique view. Usually the fracture line is transverse through the waist of Scaphoid. X-ray confirms the Dx but doesn’t exclude it. so repeat the x-ray after 2wks, it well show us the fracture more obviously.

Treatment 1-frcture of Scaphoid tubercle: Needs only crepe bandage. 2-undisplaced fractures: Treated by casting( glass-holding position) the wrist is held dorsiflexed and the thumb forwards, for 6weeks.

Treat. -After 6wks cast is removed and wrist is examined clinically and radiologically. if its not united ,we apply cast for another 6wks. -After 6wks; if no healing occurred, bone grafting and internal fixation is done.

Treat. 3-Displaced fractures: Usually treated by open reduction and internal fixation.

Complications 1- a vascular necrosis: Of proximal part, usually appears by 2-3 months. its treated by bone grafting. 2-non-union: Treated by internal fixation and bone grafting.

comp. 3-osteoarthritis: If advanced, treated by arthrodesis.