Discussion Author: Macario Camacho
The distal radius is the most common location in the upper extremity fracture site. There is a bimodal distribution in ages: younger people (athletes) and elderly (osteoporosis). FOOSH (Falling On an Out-Stretched Hand)is the most common cause.
SSx (ref 1): edema, deformity, tenderness to palpation, decreased range of motion. Absence of digital phalanx moisture can be sign of nerve damage. Lack of capillary refill within 2 seconds suggests vascular damage. 2-point discrimination can be tested with paper clip or calipers 5 mm apart over the fingertips.
Rule out a scaphoid fracture (ref 2): Pain in anatomic snuffbox.
Important bone because it spans proximal and distal carpal row, so it is key for carpal stability. Blood supply: blood supply is from the radial artery branches which enter the scaphoid bone distal to the middle third, providing the only blood supply to the proximal pole. Scaphoid fractures occurring in the most proximal 1/3 of the scaphoid may affect the blood supply and osteonecrosis and nonunion of the bone may occur.
Is there distal radioulnar joint involvement (ref 2): test the stability of the DRUJ by checking: 1. triangular fibrocartilage, 2. ulnocarpal ligament complex, 3. infratendinous extensor retinaculum (ECU tendon sheath), 4. pronator quadratus muscle, and 5. interosseous membrane. DRUJ: pain over ulnar aspect of the wrist, worsened with pronation and supination.
Image the wrist with 3-views: AP, lateral, oblique radiographs and look to see if the normal anatomy has changed (displacement, height change (ref 2) It is also important to determine if the fracture extends into the joint.
Colles fracture (ref 2): Colles' fracture is the most common distal radius fracture. Closed fracture of distal radial metaphysis. Apex of the distal fragment points in the palmar direction while the hand and wrist are dorsally displaced. Extraarticular: occurs within 2 cm of articular surface. No extension into the joint. May see ulnar styloid fracture as well.
Common in adults and rare in children because children often will have distal radial physeal injuries.
Treatment: Stable fractures: short arm cast. All other fractures should be referred for reduction and fixation.
Outcome 10 year's s/p fracture (ref 3): 5.7 â€“ 24% have osteoarthritis (OA); however, 63% of those also had contralateral wrist OA, so there may be underlying OA. Poor functional outcome can be predicted by: 1. extreme shortening, 2. intraarticular involvement and 3. stiffness of the digits after 3 months.
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