This injury pattern was actually first described by cooper in 1842, 92 years before the italian surgeon, ricardo galeazzi, reported his results of 18 cases. Malunion of distal radius fracture often results in radial shortening as the main deformity, with disturbed radioulnar variance, quite often associated with lesions of triangular fibrocartilage complex. This article highlights key concepts in the treatment of distal radial. Between august 2002 and october 2008, 27 patients treated for unstable displaced fractures of the distal radius were followed prospectively during and after open reduction and internal fixation with a volar fixed angled plate. Overuse can cause stress fractures, which are very. Distal radius fractures broken wrist orthoinfo aaos. Bone will tend to fracture at such sites, as will the cane at right.
Distal radial fractures are a relatively common group of injuries that usually occur following a fall. Distal radius fractures are one of the most common types of fractures. Despite the frequency of this fracture, only limited higherlevel evidence exists to guide practitioners in decision making for this injury. It may result from an impact to the back of the wrist, such as falling on a bent wrist. What are the different types of distal radius fractures. This is called a distal radius fracture by hand surgeons. There have also been reported cases of galeazzivariant type fracture dislocation injury in adults 7. Physical and biological aspects of fracture healing with special reference to internal fixation. Fracture of the distal radius texas tech university. A rare combination of complex elbow dislocation and distal. Factors predicting late collapse of distal radius fractures. If the broken bone punctures the skin, it is called an open or compound fracture.
In more severe cases, the bone may be broken into several pieces. In fact, the radius is the most commonly broken bone in the arm. Transverse fractures may be angulated dorsal angulation is commonest a colles fracture. The correct diagnosis and management of these fractures is crucial, as incorrect management may result in loss of normal wrist function, with significant implications on functional status and quality of life. The distal end of the radius is defined as the area three centimetres proximal to the radiocarpal joint, where the radius interfaces with the lunate and scaphoid bone of the wrist. Hip fracture, in pathology, a break in the proximal upper end of the femur hip fracture can occur at any age. The nonbridging method requires a sizeable extraarticular. However, the patient should always be questioned regarding the circumstances of the injury, especially if he or she is older. A distal radius fracture is a very common injury that can occur because of a simple fall in some cases.
These common fractures usually occur when significant force is applied to the distal radial metaphysis. Epl rupture nondisplaced distal radial fractures have a higher rate of spontaneous rupture of the extensor pollicis longus tendon extensor mechanism is felt to impinge on the tendon following a nondisplaced fracture and fracture of the distal radius. A bone fracture may be the result of high force impact or stress, or a minimal trauma injury as a result of certain medical conditions that weaken the bones, such as osteoporosis. This fracture was first described in 1814 by an irish surgeon and anatomist. Feb 19, 2019 distal radius fractures account for approximately 15% of all fractures in adults. Ulnar shortening osteotomy after distal radius fracture. The olecranon is the region of the proximal ulna from its tip to the coronoid process. Distal radial fractures are extremely common and account for about 10% to 25% of all fractures, 129 and about 17% of all fractures treated in the emergency department. Distal radius fracture is one of the most common fractures seen by orthopaedic surgeons, with an incidence of 195. It articulates with the trochlea of the distal humerus, and all olecranon fractures are therefore intraarticular fractures by definition. Rehabilitation for distal radial fractures in adults.
Heart attacks or transient ischemic attacks can cause a. Distal radius fracture is the medical term for a broken wrist. However on the ap view, it shows that both cortices are broken i. The pathophysiology of fractures chapter 5 pathology. An overview article pdf available in journal of family medicine and primary care 34. Radial head, coronoid process, and olecranon fractures are most commonly associated with elbow dislocations. Distal radius fracture wrist fracture johns hopkins medicine. This usually makes for a distinct drop in the wrist where the longer part of the radius ends. Each of these factors becomes more prevalent with advancing age, resulting in the exponential increase in the prevalence of. The radius is the larger of the two bones of the forearm. Dislocated fracture of the left distal forearm with two radial bone fragments penetrating the.
The ulnar styloid fracture rarely needs specific treatment. Radial head fracture along with an ulnar diaphyseal fracture has been described as monteggia fracture dislocation. It is a palmer angulated fracture of the distal radius with a garden spade deformity. Other causes are low bone density and osteoporosis, which cause weakening of the bones. Such injuries account for approximately onesixth of fractures treated in united states emergency departments eds 1. A line that is perpendicular to the diaphysis of the radius. The treatment of distal radius fractures summary of recommendations the following is a summary of the recommendations in the aaos clinical practice guideline, the treatment of distal radius fractures.
Request pdf rehabilitation for distal radial fractures in adults fracture of the distal radius is a common clinical problem, particularly in older white women with osteoporosis. Overview of fractures msd manual professional edition. The scope of this guideline is specifically limited to acute distal radius fractures. They recommend uso for the surgical treatment of uca after malunited distal radius fracture, for which the main deformity is moderate radial shortening with a normal radial inclination. A line drawn between the distal ends of the articular surface of the radius on a ap view of the wrist. Fractures of the distal ulna associated with fracture of. Complications of distal radial and scaphoid fracture. A colles wrist fracture occurs when the radius bone in your forearm breaks. Justin mirza of mirza orthopedics outline the different types of distal radius fractures and explain how the type of. The elbow joint is a stable joint of the hinged variety. Distal radial fractures are a heterogeneous group of fractures that occur at the distal radius and are the dominant fracture type at the wrist. The fracture is usually in the distal third of the radial shaft, just proximal to the pronator quadratus.
Fractures of the distal radius are common and frequently encountered by the radiologist. Colles fracture distal radius fracture or broken wrist. Treatment of distal radius fractures in adults norwegian orthopaedic association. Avoiding distal radius fracture complications broken wrist. A hematoma forms at the fracture site, and a small amount of bone in the distal fracture fragments is resorbed. A distal radius fracture occurs when a sudden force causes the radius bone, located on the thumb side of the wrist, to break. Classification and treatment of distal radius fractures.
Definition o chronic stress injury of distal radial physis o also known as epiphysiolysis 2. These also are the most common physeal fractures in children. Isolated scaphoid fractures can also occur and should be consider. Persons over age 65 may be unsteady on their feet, and their balance can be affected by medications. Distal radial fracture radiology reference article. A distal radius fracture almost always occurs about 1 inch from the end of the bone. Druj instability is due to disruption of the triangular fibrocartilage complex tfcc. Symptoms include pain, bruising, and rapidonset swelling. Although a broken wrist can happen in any of these 10 bones, by far the most common bone to break is the radius. In this instance, fragments are reduced by direct manipulation. 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.
Thus, the pathophysiology of fractures encompasses a multitude of factors that determine bone strength bone mass, bone quality, age, skeletal geometry and the frequency, nature, and effects of injuries figure 4. The commonest of these fractures is a transverse extraarticular fracture and where there. Current concepts in the treatment of distal radial fractures. Current concepts of internal fixation of fractures.
Distal radial fractures are among the most commonly encountered traumatic fractures of the upper extremity. A thorough understanding of the pathophysiology and treatment of distal radius fractures is important because these injuries are not limited to just the elderly population. Initial trauma mechanism, fracture pattern, associated injuries, and patient. There is often an accompanying fracture of the ulnar styloid, which may signify avulsion of the tfc insertion. Familiarity with wrist anatomy and the natural history of major fracture types is essential for appropriate management of distal radius fractures 2. Hip fracture, in pathology, a break in the proximal upper end of the femur. General info o common injury in pediatric gymnast o diagnosis made by history and physical exam confirmed with plain xrays or mri treatment often nonsurgical. High potential for functional impairment and frequent complications.
In patients 65 years of age or older, nonoperative treatment can be considered as a primary treatment for a displaced distal radius fracture. On the lateral view, there is a minimally displaced radial metaphysis, which could be mistaken for a buckle fracture. Classifying the distal radius fractures and suggesting best treatment protocols has been a herculean. Therapy services patient information fractured distal radius. Incidenceprevalence o incidence of acute gymnast wristunknown. Technically, its a break in the larger of the two bones in your forearm.
The aim of this study was to assess the influence of age, sex, distal radial ulnar joint injury druj, ulnar styloid fracture, and dorsal displacement in late collapse of distal radius fractures. Salient qualitative and quantitative features of the distal radius fracture identifiable on the routine radiography series are highlighted. Its also known as a distal radius fracture, transverse wrist fracture, or a dinnerfork deformity of the wrist. This injury may be accompanied by fractures of the ulnar styloid, the distal ulna, and the scaphoid. Modality of treatment for the distal end radius fracture. If a fracture line is not evident initially eg, in some nondisplaced fractures, one typically becomes evident about 1 week after the injury as this small amount of bone is resorbed. Pathophysiology diagnosis secondary causes osteomalacia lecture outline. Distal radius fracture is one of the most common fractures accounting for around 25% of fractures in the pediatric population and up to 18% of all fractures in the elderly age. After reduction of a displaced supracondylar humerus fracture, the distal humerus must be easy to visualize. The distal radius is the most common fracture site in the upper extremity. Fractures of the distal radius and the scaphoid are common injuries in adults.
The nonbridging method requires a sizeable extraarticular distal fracture fragment, yet offers less risk of radial. Dislocated fracture of the left distal forearm with two radial bone fragments penetrating the skin on the ulnar side of the wrist fig 1. The commonest fracture of the distal radius is a transverse extraarticular fracture which is usually seen as a transverse lucency across the distal radius in the region of the metaphysis. The most commonly broken bone in the wrist is the radius bone. May 19, 2017 this is for an assignment rehabilitation exercises phase 2 week 8 week 18 post radial fracture directed by choong eng keat music by thefatrat never be alone tasty release thefatrat windfall. Elbow dislocations with ipsilateral radial and ulnar diaphyseal fractures have also been reported in the literature 6. Distal radius fractures orthopaedic trauma association. Distal radius fractures common injury fractures of the distal radius represent approximately 16% of all fractures treated by orthopaedic surgeons three main peaks of fracture distribution. The bone that is usually broken is called the radius. In recent years, surgical fixation of these types of fractures has increased in response to improved patient outcomes. Rate of improvement following volar plate open reduction and.
Overuse can cause stress fractures, which are very small cracks in the bone. The risk of hip fracture from falls and bone loss increases with age. This is a basic article for medical students and other nonradiologists. Treatment options include conservative management, internal fixation with pins, bridging and nonbridging external fixation, dorsal or volar plating withwithout. Management, fracture reduction, and casting of distal forearm fractures and the care of pediatric midshaft forearm fractures is discussed separately.
A colles fracture or distal radius fracture is often called a broken wrist. In the united states, 1 person in 500 is treated each year for a distal radial fracture. The fractures occur through the distal metaphysis of the radius, with or without articular surface involvement. A wrist fracture is a medical term for a broken wrist. This describes the volar angulation of the distal fragment of an extraarticular fracture of the distal radius the reverse of a colles fracture, with or without volar displacement. Best practice for management of distal radial fractures bssh. The end of the bone nearest the wrist is called the distal end. If there is impaction, the fracture may be seen as a sclerotic line. In the times of hippocrates and galen, distal radius fractures drfs were thought to be wrist dislocations.
Radial head fracture along with an ulnar diaphyseal fracture has been described as monteggia. A fracture of the distal radius occurs when the area of the radius near the wrist breaks. Pathology of disease o repetitive axial loading of wrist in pronation and extension causes stress injury to distal radial physis causes injury to metaphyseal blood vessels interferes with calcification prolongs the life of chondrocytes 2. Fractures of the distal radius represent a quarter of all fractures seen clinically. The wrist is made up of eight small bones which connect with the two long forearm bones called the radius and ulna. The olecranon is the site of insertion for the triceps muscles. Although closed reduction with cast treatment of distal radius fractures continues to be the mainstay of treatment of stable fractures, operative methods have. If there is clinical instability after radius fixation the ulnar styloid base fracture or druj needs to be stabilized. Aug 06, 2018 the pathophysiology of a fracture is rather obvious. The break can occur in many different ways, however.
Although the pediatric and elderly populations are at greatest risk for this injury, distal radius fractures still have a significant impact on the health and wellbeing of young adults. Distal radial fracture summary radiology reference. Postmenopausal women with distal radial fracture siris et al. Excessive radial shortening after fracture of the distal radius may be associated with tears of the triangular fibrocartilage complex 16, 17. Full clinical practice guideline pdf on the treatment of distal radius fractures appropriate use criteria appropriate use criteria auc provide treatment recommendations on a patientspecific level using evidence from aaos clinical practice guidelines, along with clinician expertise and experience. Radial inclinationthe articular surface of the distal radius exhibits approximate. Comparison between surgical and conservative treatment. Although fractures of the distal radius are a common clinical presentation, many factors affect instability of these injuries. Classification of distal radius fractures wikipedia. Guideline treatment of distal radius fractures in adults magic app. Fractures of the distal radius are the most common fracture in adults and are typically caused by a fall on the outstretched hand.
The end of the distal radius typically shifts down toward the palm side in this type of fracture. Decision for surgery was made in all cases by the senior surgeon based on fracture pattern and degree of displacement. Therefore, the medical term for the most common type of broken wrist is a distal radius fracture that is, the larger forearm bone is broken near the wrist. Distal radius fractures scott wolfe md upper extremity surgeon. Treatment decisions must arise from careful diagnoses of the fracture and communication with the patient. In the presence of severe radial shortening and decreased radial inclination, they suggest combined corrective osteotomy of the distal radius. There is a case for specialist assessments, likely by physiotherapist, with. One of the most common distal radius fractures is a colles fracture, in which the broken fragment of the radius tilts upward. Fracture of the radial head and coronoid process along with posterior dislocation is called the terrible triad. The radial inclination of a distal radius fracture is shown in red in image at right. Distal radius fracture wrist fracture johns hopkins. Fractures commonly happen because of car accidents, falls, or sports injuries. Epl rupture nondisplaced distal radial fractures have a higher rate of spontaneous rupture of the extensor pollicis longus tendon extensor mechanism is felt to impinge on the tendon following a nondisplaced fracture and.
1523 593 1113 765 18 898 347 1436 333 303 962 1063 774 866 300 1574 1038 775 1455 1462 625 1092 1081 986 745 1076 669 407 554 1007 1195 726 469 564