Plain radiographs are the quickest and definitive investigations of most fractures (Fig. Forearm fracture (such as Galeazzi or Monteggia fractures).*Ask for an ‘okay’ sign, if the DIPJ of the 2 nd digit and IPJ of thumb extend, this signifies AIN nerve involvement Differential Diagnosis The main risk factors for distal radius fractures are related to osteoporosis: Figure 2 – Schematic demonstrating difference in mechanism of injury and bony injury between (A) Colles’ fracture (B) Smith’s fracture Figure 1 - The Articular Surfaces of the Wrist Joint Pathophysiology Patients will be then placed in a cast to ensure ongoing immobility for a few weeks. Options of surgical management include open reduction and internal fixation (ORIF) with plating, or K-wire fixation. Any fracture with an intra-articular step of the radiocarpal joint >2mm is also advised to be surgically corrected. Significantly displaced or unstable fractures can require surgical intervention, as they have a risk of displacing further over time if not stabilised.
#ACUTE BUCKLE FRACTURE WRIST FULL#
Once sufficient bone healing has occurred, patients should be rehabilitated via physiotherapy to ensure the regaining of full function. Stable and successfully reduced fractures can typically be placed in a below-elbow backslab cast, then radiographs repeated after 1 week to check for displacement. This can be performed under conscious sedation with a haematoma block or Bier’s block.įollowing reduction, the arm should be restricted to allow for bone healing. Various techniques can be employed, however all involve ensuring sufficient traction and manipulation under anaesthetic. Once stabilised, all displaced fractures require closed reduction in the emergency department. *Ask for an ‘okay’ sign, if the DIPJ of the 2 nd digit and IPJ of thumb extend, this signifies AIN nerve involvementĪs for any trauma case (beyond the scope of this article), suitable resuscitate and stabilisation of the patient is the priority. Radial nerve: motor – extension of IPJ of thumb sensory – dorsal surface of 1 st webspace.Ulnar nerve: motor – adduction of the thumb (‘Froment’s Sign’) sensory – ulnar surface of the distal 5 th digit.Anterior interosseous nerve: opposition of the thumb and index finger*.Median nerve: motor – abduction of the thumb sensory – radial surface of distal 2 nd digit.The neurological examination for a suspected distal radius fracture should include the following nerves being assessed:
On examination, it is important to assess for any evidence of neurovascular compromise check nerve function (see below) and limb perfusion (capillary refill time and pulses). Additionally, remember to examine the joints above and below to identify occult injuries. Any neurological involvement can also result in paresthesia or weakness. Patients with a distal radius fracture typically present following an episode of trauma, complaining of immediate pain +/- deformity and sudden swelling around the fracture site. This is an intra-articular fracture of the distal radius with associated dislocation of the radio-carpal joint.Ī Barton fracture can be described as volar (more common) or dorsal (less common), depending on whether the volar or dorsal rim of the radius is involved. This type of fracture is caused by falling backwards and planting the outstretched hand behind the body, causing a forced pronation type injury (Fig. This describes the volar angulation of the distal fragment of an extra-articular fracture of the distal radius (the reverse of a Colles fracture), with or without volar displacement. *By definition, a Colles’ fracture also includes an avulsion fracture of the ulnar styloid, however this feature may not always be present in those described as such Smith’s Fracture The transfer of load as their body falls forces the wrist into supination (Fig. It occurs when a person falls forwards and plants their outstretched hand in front of them. This type of fracture typically occurs as a “ fragility fracture” in osteoporotic bone. Classification Colles’ FractureĪ Colles’ fracture* describes an extra-articular fracture of the distal radius with dorsal angulation and dorsal displacement, within 2cm of the articular surface. A FOOSH causes a forced supination or pronation of the carpus this in turn increases the impaction load of the distal radius. The distal radius takes 80% of the axial load underneath the scaphoid and lunate fossae. However, children between 5-15yrs are also prone to these fractures. Due to osteoporosis, the risk of these fractures increases with age (termed ‘fragility fractures’). Distal radius fractures are most commonly caused by a fall on an outstretched hand (FOOSH).
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