File Name: fractures and injuries of the distal radius and carpus .zip
Kastenberger, T. Arthroscopic assisted treatment of distal radius fractures and concomitant injuries.
- Fractures of Distal Radius: An Overview
- Distal radius fracture
- Distal Radius Fractures
- Distal Radius Fractures
Fractures of Distal Radius: An Overview
A distal radius fracture , also known as wrist fracture , is a break of the part of the radius bone which is close to the wrist.
In younger people, these fractures typically occur during sports or a motor vehicle collision. Treatment is with casting for six weeks or surgery. Distal radius fractures are common,  and are the most common type of fractures that are seen in children. People usually present with a history of falling on an outstretched hand and complaint of pain and swelling around the wrist, sometimes with deformity around the wrist. Any pain in the limb of the same side should also be investigated to exclude associated injuries to the same limb.
Swelling, deformity, tenderness, and loss of wrist motion are normal features on examination of a person with a distal radius fracture.
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 especially at the tips of the radial three and one half digits thumb, index finger, middle finger and radial portion of the ring finger 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 which can manifest as severe pain and sensory deficits in the hand.
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.
For children and adolescents, there are three main categories of fracture: buckle torus fractures , greenstick fractures , and complete or off-ended fractures. Buckle fractures are stable and are the most common type. Complete fractures, where the bone is completely broken, are unstable.
In a complete fracture the bone can be misaligned. An open fracture exposed bone is a serious injury. 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. 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.
Most children with these types of fractures do not need surgery. 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.
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. 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.
Despite these risks with nonoperative treatment, more recent systematic reviews suggest that when indicated, nonsurgical management in the elderly population may lead to similar functional outcomes as surgical approaches.
In these studies, no significant differences in pain scores, grip strength, and range of motion in patients' wrists occurred when comparing conservative nonsurgical approaches with surgical management.
Although the nonsurgical group exhibited greater anatomic misalignment such as radial deviation, and ulnar variance, these changes did not seem to have significant impact on overall pain and quality of life.
Surgery is generally indicated for displaced or unstable fractures. The choice of operative treatment is often determined by the type of fracture, which can be categorized broadly into three groups: partial articular fractures, displaced articular fractures, and metaphyseal unstable extra- or minimal articular fractures.
Significant advances have been made in ORIF treatments. Two newer treatments are fragment-specific fixation and fixed-angle volar plating. These attempt fixation rigid enough to allow almost immediate mobility, in an effort to minimize stiffness and improve ultimate function; no improved final outcome from early mobilization prior to 6 weeks after surgical fixation has been shown.
The alignment of the DRUJ is also important, as this can be a source of a pain and loss of rotation after final healing and maximum recovery. An arthroscope can be used at the time of fixation to evaluate for soft-tissue injury and the congruity of the joint surface and may increase the accuracy of joint surface alignment  Structures at risk include the triangular fibrocartilage complex and the scapholunate ligament.
Scapholunate injuries in radial styloid fractures where the fracture line exits distally at the scapholunate interval should be considered. Prognosis varies depending on dozens of variables. If the anatomy bony alignment is not properly restored, function may remain poor even after healing. Restoration of bony alignment is not a guarantee of success, as soft tissue contributes significantly to the healing process.
These fractures are the most common of the three groups mentioned above that require surgical management. Manipulative reduction and immobilization were thought to be appropriate for metaphyseal unstable fractures. However, several studies suggest this approach is largely ineffective in patients with high functional demand, and in this case, more stable fixation techniques should be used.
Surgical options have been shown to be successful in patients with unstable extra-articular or minimal articular distal radius fractures. These options include percutaneous pinning, external fixation, and ORIF using plating.
Patients with low functional demand of their wrists can be treated successfully with nonsurgical management; however, in more active and fit patients with fractures that are reducible by closed means, nonbridging external fixation is preferred, as it has less serious complications when compared to other surgical options.
Distal radius fracture
Introduction. Distal radius fractures are one of the most common injuries lip of the distal radius with displacement of carpus with the. fragment.
Distal Radius Fractures
Professional Reference articles are designed for health professionals to use. You may find the Scaphoid Wrist Fracture article more useful, or one of our other health articles. NICE has issued rapid update guidelines in relation to many of these.
Various authors have documented wrist ligament injuries in patients with distal radius fractures DRFs. We conducted a study to determine whether scapholunate interosseous ligament SLIL , triangular fibrocartilage complex TFCC , or chondral injuries directly assessed with arthroscopy predict DRF outcomes. Forty-two patients who underwent open reduction and internal fixation of DRFs were enrolled in the study.
Distal Radius Fractures
Fractures of the distal radius represent a quarter of all fractures seen clinically. The fractures occur through the distal metaphysis of the radius , with or without articular surface involvement. However, children between yrs are also prone to these fractures. A FOOSH causes a forced supination or pronation of the carpus; this in turn increases the impaction load of the distal radius. It occurs when a person falls forwards and plants their outstretched hand in front of them.
Initial assessment includes a history of mechanism of injury, associated injury and appropriate radiological evaluation. However, many questions regarding these fractures remain unanswered and good prospective randomized trials are needed. Distal radius fractures are one of the most common injuries encountered in orthopedic practice. Barton's fracture is the displaced intra-articular coronal plane fracture-subluxation of dorsal lip of the distal radius with displacement of carpus with the fragment. Reverse Barton's occurs with wrist in palmar-flexion and involves the volar lip. Chauffer's fracture was described as originally occurring due to backfire of the car starter handles in older models.
Metrics details. The aim of this study is to investigate the morphological characteristics of distal radius die-punch fracture DRDPF with different types, based on the three-column theory. The imaging data of patients diagnosed with DRDPF were reviewed and divided into single-column, double-column, or three-column DRDPF according to the three-column theory, and the types, case distribution of DRDPF, and inter- and intra-agreement of classification were further analyzed. Among the single-column DRDPF, there were three cases of volar, 13 cases of dorsal, 14 cases of split, and 35 cases of collapse type fractures. Among the radius column fracture, there were cases of metaphseal, cases of articular surface, and cases of combined type.
Все лампы наверху погасли. Не было видно даже кнопочных электронных панелей на дверях кабинетов. Когда ее глаза привыкли к темноте, Сьюзан разглядела, что единственным источником слабого света в шифровалке был открытый люк, из которого исходило заметное красноватое сияние ламп, находившихся в подсобном помещении далеко внизу. Она начала двигаться в направлении люка. В воздухе ощущался едва уловимый запах озона. Остановившись у края люка, Сьюзан посмотрела. Фреоновые вентиляторы с урчанием наполняли подсобку красным туманом.
Коммандер. Северная Дакота - это Грег Хейл. Сьюзан едва ли не физически ощутила повисшее молчание.
Бринкерхофф читал, не веря своим глазам. - Какого чер… В распечатке был список последних тридцати шести файлов, введенных в ТРАНСТЕКСТ. За названием каждого файла следовали четыре цифры - код команды добро, данной программой Сквозь строй.