Distal Radius Fracture Types, diagnosis, and treatment. скачать в хорошем качестве

Distal Radius Fracture Types, diagnosis, and treatment.

Common types of distal radius fractures. We need to know a few things about the anatomy, a few things about the X-ray, and what we look for. It's not just, uh, the fracture. We need to look at the radioulnar joint, sigmoid notch, lunate fossa, scaphoid fossa, and ridge between the two fossae. We also need to look at the carpal bones, especially the lunate and the scaphoid. Also, we need to consider the triangular fibrocartilage and the deforming forces of the brachioradialis. So, what are the most common types of distal radius fractures? The most common type is Colles' fracture, a fracture of the distal radius with characteristic backward displacement of the hand. It is a low-energy fracture, extra-articular with dorsal displacement of the distal fragment. It usually occurs in patients above the age of 50 years when they attempt to break a fall with an outstretched hand. The fracture is sometimes referred to as a dinner fork deformity fracture due to the shape of the fractured forearm. You can see that the deformity looks like a dinner fork and, uh, you see the dorsal displacement of the distal fragment. TFCC tears occur in about 50% of extra-articular distal radius fractures versus one-third in inter-articular fractures. The dorsal comminution is significant. If the comminution is up to 50% of the dorsal cortex, then treatment with a cast will not work. Some people believe one-third of the cortex comminution will prohibit using a cast. The more dorsal comminution, the more dorsiflexion of the fragment, the greater the chance that the fracture would not be treated adequately with a cast, and the cast treatment will fail. Colles' fracture that extends to the DRUJ has the worst prognosis. Another type is a Smith fracture. Predominantly, it is an extra-articular transverse fracture that's palmarly displaced and is always thought to be a reverse Colles' fracture. You can see that the fracture fragment is displaced ventrally or palmarly. It could occur from a fall onto a flexed wrist. A Smith fracture has multiple types. Type I is the most common type of extra-articular transverse fracture through the distal radius. Type II, the fracture crosses into the dorsal articular surface. And type III enters the radiocarpal joint, similar to a volar Barton fracture. So, volar Barton fracture equals a Smith type III fracture. Both will involve the inter-articular distal radius and possibly dissociation of the carpal bones. You can see the three types of Smith fractures, and type III looks like a volar Barton fracture. And type I looks like a Colles' fracture, but it's a reverse one. Look at the volar direction of the fragment. Volar approach and plating and supporting this fragment is usually the treatment for this fracture. Here you can see the difference between Colles' fracture and the Smith fracture from the displacement of the fracture. The Colles' is dorsal. The Smith is palmar or volar. The other type is a die punch fracture. A die punch fracture is a depressed fracture of the lunate fossa from an axial load transmitted through the lunate bone. They are inter-articular fractures of the lunate fossa. Always check to see if there is any other carpal bone dissociation. Another interesting type is Barton fracture, an inter-articular fracture of the distal radius with dislocation of the radiocarpal joint. This fracture can be either dorsal or volar. Check for carpal disruption or dissociation. Barton's fracture is caused by a fall on an extended and pronated wrist. Usually, the volar type is the most common, and the fragment is usually a minor dorsal Barton fracture. The volar Barton fracture is the fracture of the volar margin of the distal radius, which is associated with subluxation of the radiocarpal joint. The most striking finding is subluxation or dislocation of the wrist with that small fragment. In that picture, the strong volar radiocarpal ligament avulses the volar lip of the radius, and the hand and the wrist are dislocated with that fracture fragment. This fracture is very similar to a Smith type III fracture. The treatment of volar Barton's fracture is usually surgery using a volar approach and volar plate. Dorsal Barton, dorsal shearing force, the distal radius fracture with dislocation of the radiocarpal joint, the fracture is inter-articular, it involves the dorsal lip, and the wrist is dislocated. The avulsed fragment is usually small. The treatment is open reduction internal fixation through a dorsal approach. The last type is the chauffeur fracture, which is a styloid process fracture with a scapholunate dissociation. It's caused by compression of the scaphoid against the styloid process, shearing it off, and you probably will have a scapholunate dissociation at that point.