2/8/2024 0 Comments Colles smith fracture fork![]() Extra-articular fracture with acceptable shortening (< 5 mm) and dorsal angulation ( < 5 degrees or within 20 degrees of the contralateral side)- Closed reduction and immobilization with a cast or splint.Ģ. The fracture is named after an Irish surgeon, Abraham Colles, who originally documented the injury in 1814 ,interestingly BEFORE the inception of radiographs. Transverse fracture involves distal radioulnar jointĬomminuted fracture with the involvement of both the radiocarpal and radioulnar jointsįrykman Classification of Distal Radial Fractures Type III fracture plus ulnar styloid fracture TypeĮxtra-articular transverse metaphyseal fracture (eg- Colles and Smith’s fractures)įractures involving the radiocarpal joint (eg-Chauffeur fractures, Barton fractures, and reverse Barton) Secondary osteoarthritis is frequently seen in intra-articular involvement.įrykman Classification for distal radial fracturesīased on the extra or intra-articular involvement, the fractures of the distal radius and ulna, are divided into eight different types.Risk factors – osteoporosis, a fall on an outstretched arm, athletic injuries, motor vehicle accidents.Age/Sex predilection- Bimodal age distribution in young athletes and elderly women>men. ![]() Symptoms: Wrist pain, swelling, and tenderness, restricted range of motion, deformed shape of the wrist.Chauffeur fractures- intra articular fracture of the radial styloid process frequently non displaced.Barton’s fracture- distal radius fracture involving the dorsal aspect to the articular surface of the distal radius with intra-articular extension.Smith’s fracture- distal radial metaphyseal fracture caused by a fall on an outstretched hand causing volar angulation of the distal fracture fragment.If there are concerns for an intraarticular fracture, CT can be obtained. Imaging Recommendation:Ī radiograph with two orthogonal views (AP and Lateral ) is the investigation of choice. MRI – used to assess ligament or soft tissue injuries, such as TFCC, scapholunate or lunotriquetral ligament injuries. Is there fracture of the ulnar styloid?ĬT scan- in comminuted fracture to delineate fracture pattern and to rule out intra-articular component.Is there subluxation or dislocation of the distal radioulnar joint?.Is there abnormal dorsal or, less likely, volar tilt of the articular surface?.Is there intraarticular (radiocarpal or distal radioulnar joint involvement)?.Radiology Reporting Checklist for Distal Radial Fractures Excessive dorsal angulation can be associated with TFCC tears. Volar tilt : Angle between a line perpendicular to the central axis of the radius and a line connecting the dorsal and volar margins of the articular surface of the distal radius on the lateral view.A value of more than 0.15 is a significant independent risk factor of distal radioulnar joint instability following unstable distal radius fracture. Radial translation ratio: The ration of the distal radioulnar joint gap relative to the radioulnar width of the proximal fracture fragment reflects the radial translation ratio.Positive ulnar variance is seen when the distal articular surface of the ulna is more than 2.5 mm distal to the articular surface of the radius. With excessive radial shortening, ulnar positive variance will be present which can lead to ulnar impaction syndromes and thinning of the triangular fibrocartilage complex. Ulnar variance: Vertical distance between line drawn at the level of the radial sigmoid notch and a second line at the level of the lateral cortical margin of the distal ulna.There is flattening of the radial articular surface in distal radial fractures. Radial inclination : Radial inclination is the angle between a line perpendicular to the central axis of the radius and a line connecting the radial and ulnar limits of the articular surface of the distal radius, normally 13-30 degrees.Excessive shortening of the radial length is associated with injuries of the triangular fibrocartilage complex (TFCC). Radial length: Two lines are drawn perpendicular to the long axis of the radius, one at the tip of the radial styloid and the second at the ulnar border of the distal radial articular surface, normally about 12mm.Greater than 5 mm or alternatively, resultant ulnar positive variance.Dorsal tilt greater than 20°, radial inclination less than 15°, radial shortening.Often associated with ulnar styloid fracture and radial shortening. Fracture of the distal metaphysis of the radius with dorsal angulation of the distal fragment.PathophysiologyĬolle fracture is characterized as an extra-articular fracture of the radial metaphysis caused by a fall on an outstretched hand (FOOSH), typically pronated forearm in wrist extension) causing dorsal angulation of the distal fracture fragment. Answer: Volar angulation of the distal fracture fragment seen in Smith fracture.
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