Distal radius fracture overview
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Distal radius fracture Microchapters |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Rohan A. Bhimani, M.B.B.S., D.N.B., M.Ch.[2]
Overview
Distal radius fractures are one of the most common injuries encountered in orthopedic practice. They make up 8%−15% of all bony injuries in adults. Abraham Colles is credited with description of the most common fracture pattern affecting distal end radius in 1814, and is classically named after him. Colles’ fracture specifically is defined as metaphyseal injury of cortico-cancellous junction (within 2−3 cm of articular surface) of the distal radius with characteristic dorsal tilt, dorsal shift, radial tilt, radial shift, supination and impaction. Smith's fractures, also referred to as reverse Colles’ fracture, have palmar tilt of the distal fragment. Barton's fracture is the displaced intra-articular coronal plane fracture-subluxation of dorsal lip of the distal radius with displacement of carpus with the fragment. Reverse Barton's occurs with wrist in palmar-flexion and involves the volar lip. Chauffer's fracture was described as originally occurring due to backfire of the car starter handles in older models. It involves an intra-articular fracture of radial styloid of variable size.Intra-articular component in distal radius fractures usually signifies high-energy trauma occurring in young adults. High-energy injuries frequently cause shear and impacted fractures of the articular surface of the distal aspect of the radius with displacement of the fracture fragments. The fracture pattern most commonly observed in geriatric age group is extra-articular while the high-energy intra-articular type is most frequent in young adult patients.There are multiple classifications available for distal radius fractures. The most common classification systems for distal radius fractures include Frykman, Melone, Fernández, Universal, and AO classification. Many Distal radius fractures can be treated nonoperatively. Those that are undisplaced or minimally displaced can be treated in a cast for 6 weeks. Mainly type I and type IIA Melone's fracture can be managed conservatively. In elderly, cast immobilization provided functional outcomes similar to those achieved with surgical treatments. Surgical management of distal radius fracture can present many challenges, particularly in patients with multiple fracture fragments, extensive articular comminution, or metadiaphyseal bone loss. Understanding the column model of distal radius fractures and the goals of reconstruction can be extremely beneficial in preoperative planning and intraoperative decision making. Successful surgical management of complex distal radius fracture requires versatility in surgical approaches and techniques in addition to familiarity with a variety of fixation methods such as volar locking plate, dorsal locking plate, distraction bridge plate and external fixation.