• +27 (0)21 879 4264
  • info@assicfitness.com
  • My account
  • Cart

  • Home
  • Applications
    • Resting Heart Rate
    • Recovery Heart Rate
    • Fitness
    • Performance Fingerprint
    • Strength and Conditioning
  • Health Professionals
    • Find your Professional
    • Book a Professional
  • Education
    • Know your Body
      • Body profile
      • Cardiac
      • Exercise/Rehab Routines
      • Fitness
      • Fluid Balance
      • Muscle
      • Bone/Tendon/Joint
      • My Surgery
      • Yoga
      • Nutrition
    • Blog
      • Articles
      • Monthly Routines
      • News and Opinion Pieces
    • COVID-19
      • What You Need to Know
      • Overview of COVID-19
      • COVID-19 Map
    • How to Use the Apps
      • Performance Fingerprint
      • COVID-19 Vitals
      • Connecting Professionals
    • Biomarkers
      • COVID-19
      • Infection/Inflammation
      • Endurance
      • Hydration
      • Performance Fatigue
      • Metabolism
      • Muscle Cramps
      • Nutrition
    • Medical
      • Hip
      • Knee
      • Ankle/Foot
      • Shoulder
      • Elbow
      • Wrist/Hand
      • Back
  • Health Calculators
  • About
    • Contributors
      • Become a Contributor
    • Partners
      • Lancet Laboratories
    • Professionals
    • Press
    • Professional Dual View Access Application
  • Contact
✕

Distal Radius Fractures

Categories
  • Hand
  • Joint/Tendon
Tags
  • Hand injury
Hand

Upper Limb Anatomy

Right shoulder and arm, posterior view
Right shoulder and arm, posterior view

Right shoulder and arm, posterior view

Normal Upper Limb Anatomy
Triceps Brachii Muscle
Upper Limb Anatomy (Arm)
Muscles of the Forearm
Muscles of the Forearm
Upper Limb Anatomy (Nerve)
Medial aspect of right forearm

Medial aspect of right forearm

Left Brachial plexus

Left Brachial plexus

Nerves Posterior to Elbow Joint

Posterior view of right elbow

Posterior view of right elbow

Blood supply around the elbow joint

Blood supply and anastomosis

Blood supply and anastomosis around the right elbow. Anterior view

Elbow Joint

Elbow joint structural stability structures

Elbow joint structural stability structures

Left Arm

Left arm
Left arm
Humerus

Distal Humerus Biomechanics

The triangular structure of distal humerus at elbow joint provides structural strength.

Anterior view right distal humerus bone

Anterior view right distal humerus bone

Rotation around throchlear axis

The elbow joint is a hinge joint with axis of rotation around throchlear axis

Extensor muscles

Extensor muscles

Resisted finger flexion

Flexor muscles

Bone Structure
Haversion bone system

Haversion bone system

Distal Radius Fracture

  • Distal radius fractures a common orthopaedic injury
  • The mechanism usually a fall to the outstretch arm
  • More common in females

Risk factors:

  • Osteoporosis

Presentation:

  • Pain
  • Swelling
  • Deformity

Clinically:

  • Bone tenderness

Investigations:

  • X-ray
  • CT: for intra-articular fracture evaluation and surgical planning
  • MRI: useful to evaluate soft tissue injuries that include the carpal ligaments (scapholunate, lunotriquetral or TFCC associated injuries)
Distal radius fracture

Injury mechanism

Injury mechanism

Wrist/forearm position while falling producing either a Colles’ fracture or Smith fracture. When there is a partial dorsal or volar fragment extending to the wrist joint in the sagittal plane then the fracture is termed a dorsal or volar Barton fracture respectively.

Frykman Classification for Distal Radius Fracture

Frykman classification for distal radius fracture

Wrist/forearm position while falling producing either a Colles’ fracture or Smith fracture. When there is a partial dorsal or volar fragment extending to the wrist joint in the sagittal plane then the fracture is termed a dorsal or volar Barton fracture respectively.

Chauffers’ Fracture

  • Radius styloid fracture
  • Exclude scapholunate associated injury
Chauffers fracture

Radial styloid fracture. Assess and exclude potential scapholunate disruption

AO classification for Distal Radius Fracture

AO classification for distal radius fracture
LaFontaine predictors of radius fracture instability

Acceptable Malunion for Distal Radius Fracture

Acceptable malunion for distal radius fracture
Acceptable malunion for distal radius fracture
Acceptable malunion for distal radius fracture

Management

Non surgical with immobilization in a splint/cast for closed fractures that are:

  • Extra-articular
  • < 5mm radial shortening
  • Dorsal angulation < 5° or within 20° of contralateral side

Surgery:

  • For fractures not compliant with conservative criteria
  • Unstable fractures including (articular margin), dorsal and volar Bartons’ fractures,/li>
  • Comminuted and displaced extra-articular fractures (Smiths’ fracture)
  • Associated volar/dorsal comminution
  • Associated ulnar fracture
  • Articular incongruency > 2mm
  • Die-punch fractures
  • Open fractures

Options:

  • Plate and screw fixation
  • External fixator for open fractures, complex intraarticular fractures
Distal radius fracture

Conservative distal radius fracture management
using cast /Plaster of Paris

Conservative distal radius fracture

Principles of fracture reduction and immobilization in cast/Plaster of Paris (POP).

Avoid extreme wrist flexion and ulnar deviation when positioning and molding a Colles’ fracture in POP, thereby preventing carpal tunnel syndrome (Cotton-Loder Position)

Factors associated with instability following closed reduction of distal radius fractures:

Injury factors:

  • More than 5 mm shortening
  • Dorsal tilt > 20°
  • Articular displacement > 2mm
  • Displacement > 2/3 shaft width in any direction
  • Dorsal metaphyseal comminution
  • Associated Ulnar fracture

Patient Factors:

  • Osteoporosis

Surgery

Plate and screw fixation

Plate and screw fixation

Closed distal complex radius fracture

Closed distal complex radius fracture with wrist spanning external fixator

Surgery Technique

Surgery

Anterior (Henry approach) to forearm

Superficial skin anatomy landmarks:

  • Proximal: biceps tendon, medial to brachioradialis
  • Distal: radial styloid process
Anterior (Henry approach) to forearm
Brachioradialis & flexor carpi radialis

Superficial: Brachioradialis & flexor carpi radialis. Radial artery lies deep to brachioradialis in middle forearm and distally between brachioradialis and flexor carpi radialis. Superficial Radial nerve lies under brachioradialis.

Deep dissection: Middle third lateral border of pronator teres. Distal third lies flexor pollicis longus & pronator quadratus. Classic Henry approach is between brachioradialis and radial artery or modified Henry approach between radial artery and flexor carpi radialis. The radial artery is retracted laterally while flexor carpi radialis is retracted medially. With flexor pollicis longus also retracted medially pronator quadratus is exposed.

Surgery technique principles for distal radius ORIF

Surgery technique principles for distal radius ORIF

Anterior (Henry) approach to distal radius shaft. Release Brachioradialis at radius styloid process and make radial incision over pronator quadratus.

Plate & screw fixation radius

Surgery technique principles for distal radius ORIF

Open distal radius fractures

Open distal radius complex fracture

Open distal radius complex fracture

Open distal radius fracture

Open distal radius fracture with external wrist spanning external fixator with wound vacuum suction dressing

Surgical technique

Distal Radius Surgical technique
  • Open wound debridement and curettage
  • Apply vacuum suction dressing after debridement
  • Application of external fixator: 2 Doral distal radius pin insertion with 2 pins inserted to the dorsal aspect of 2nd metatarsal

Post Operative Rehabilitation

  • Rigid fixation: arm sling for 7-10 days then elbow range of motion, non-weight bearing
  • Suboptimal fixation may require extended splintage
  • Strengthening exercises after fracture union
Arm sling

Arm sling

Hand grip exercises with arm in splint

Hand grip exercises with arm in splint

Forearm strength exercise

Forearm strength exercise

Download ASSIC Performance Fingerprint or Strength & Conditioning apps for rehab guideline routines or create own under professional supervision

apple app store  google play store

References

  1. A comparative Biomechanical Analysis of 2 Double-Row, Distal Triceps Tendon Repairs. Matthew A Dorweiler, Rufus O Van Dyke, Robert C Siska, Michael A Boin and Mathew J DiPaola. The Orthopaedic Journal of Sports Medicine May 2017, 5(5): 23259671177080.
  2. Traumatic elbow injuries: what the orthopedic surgeon wants to know. Sheehan S.E. Radiographics 33(3(: 869-888.
  3. A follow-up of one hundred cases of fracture of the head of the radius with a review of the literature. Johnston GW. Ulster Med J 31: 51-56.
  4. Management of severely comminuted distal radius fractures. David M Brogan, Marc J Richard, David Ruch, Sanjeev Kakar. J Hand Surg Am. 2015 Sep; 40(9): 1905-14.
  5. Surgical management for olecranon fractures in adults: a systematic review and meta-analysis. Koziarz A, Woolnough T, Oitment C, Nath S, Johal H. Orthopedic. 2019 Mar 1;42(2): 75-82.
  6. Classifications in Brief: Mayo classification of olecranon fractures. Sullivan CW, Desai K. Clin Orthop Relat Res. 2019 Apr;477(4): 908-910.
  7. Elbow fractures. Midtgaard KS, Ruzbarsky JJ, Hackett TR, Viola RW. Clin Sports Med. 2020 Jul;39(3): 623-636.
  8. Comparison of outcome between nonoperative and operative treatment of medial epicondyle fractures. Petra Grahn, Tero Hämäläinen, Yrjänä Nietosvaara, Matti Ahonen. Acta Orthop. 2021 Feb;92(1): 114-119.
  9. A narrative review on avulsion fractures of the upper limb and lower limbs. Christopher Vannabouathong, Olufemi R Ayeni, Mohit Bhandari. Clin Med Insights Arthritis Musculoskelet Disord. 2018;11: 1179544118809050.
  10. Outcome after ORIF of capitellar and trochlear fractures. JH Dubberley, KJ Faber, JC Macdermid, SD Patterson, GH King. J Bone Joint Surg Am. Vol. 88 2006: 46-54.
  11. Coronal plane partial articular fractures of the distal humerus: current concept in management. DE Ruchelsman, NC Tejwani, YW Kwon, KA Egol. J Am Acad Orthop Surg. Vol 16 2008: 716-728.
  12. Complex elbow dislocations and the “terrible triad” injury. Allistair D R Jones, Robert W Jordan. Open Orthop J. 2017 Nov 30;11: 1394-1404.

Related posts

Ankle
Jun 17, 2022

Posterior Tibial Tendon Dysfunction Syndrome


Read more
Shoulder
Jun 13, 2022

Acromioclavicular Joint Subluxation


Read more
Ankle
Jun 10, 2022

Sever’s Disease


Read more
Hand
Jun 10, 2022

Intersection syndrome


Read more
assic fitness and health white logo

ASSIC is a pioneering technology based Sports Science Company designing tools to assist in personal fitness management for individuals and professional athletes.

Education

  • Home
  • Applications
  • Health Professionals
  • Education
  • Health Calculators
  • About
  • Contact

Our Applications

  • Resting Heart Rate
  • Recovery Heart Rate
  • Fitness
  • Strength and Conditioning
  • Performance Fingerprint
  • Medical Examination

Download our Applications

apple app store
google play store
© 2022 ASSIC Medical (PTY) Ltd. All Rights Reserved. Created and Hosted by: Lava Lamp Lab
0

R0.00

  • My account
  • Cart
✕

Login

Lost your password?

Create an account?

Change Location
Find awesome listings near you!